PRIVATE BUSINESS

Mersey Tunnels Bill (By Order)

Order for further consideration, as amended, read.
	To be further considered on Tuesday 15 July.

Oral Answers to Questions

FOREIGN AND COMMONWEALTH AFFAIRS

The Secretary of State was asked—

EU Member-Designate Countries

Keith Vaz: What steps the Government are taking to support the EU member-designate countries which will join on 1 May 2004.

Denis MacShane: The Government remain committed to ensuring that the 10 countries joining the EU on 1 May next year are ready to do so. The UK has provided bilateral assistance to the candidates worth over £350 million since 1989. On the practical side, there are more than 50 UK civil servants working full-time on twinning projects in the candidate countries.

Keith Vaz: While I congratulate my hon. Friend the Minister and my right hon. Friend the Foreign Secretary on their excellent work in pushing forward the enlargement process, will my hon. Friend assure the House that the Government will give every possible assistance to the member-designate countries that have received early-warning letters from the EU Commission to ensure that the outstanding obstacles are dealt with? Does he agree that it would be most embarrassing and disappointing if the EU's first act on 1 May 2004 were to take infraction proceedings against one of its new members?

Denis MacShane: My hon. Friend is right. Equally, however, all candidate countries must conform to EU norms. From May next year, they will be full members of the EU. Just as any existing EU member state can receive such infraction letters, other states must stand ready for them. As I said, we are working as one of the lead countries in ensuring that the incoming member states are ready to be full and active members of the EU as of May next year.

Andrew MacKay: In warmly welcoming the incoming member states, will the Minister confirm that he has deprecated the bellicose remarks of the French President at the time of the Iraq war, and of the French Defence Minister when she visited Warsaw? Will he stress to the member-designate states that we believe in a deeper rather than a wider—I am sorry, I mean a wider rather than a deeper Europe?

Denis MacShane: The right hon. Gentleman is correct to draw attention to remarks that were certainly unfortunate. I hope, therefore, that he will join me in not deprecating but condemning the fact that the Conservative MEPs Roger Helmer and Daniel Hannan have been in Estonia campaigning for a no vote, and that Lady Thatcher has sent a letter to the Estonians calling on them to vote no to Europe. I hope that the Conservative party will now dissociate itself from Lady Thatcher and withdraw the Whip from those MEPs. Conservative Front-Bench Members cannot say that they are in favour of enlargement when they send their agents and propaganda to campaign for a no vote to isolate Britain further from Europe and get countries that want to join the EU to—

Mr. Speaker: Order. I call Mr. Knight.

Jim Knight: Given the presumption among some hon. Members that public opinion is against Europe and the euro, will my hon. Friend comment on public opinion in member-designate countries, as expressed in the referendums that have taken place so far?

Denis MacShane: There have been open referendums and solid votes in favour of joining the EU. It is quite remarkable that the countries that have freed themselves from the Soviet yoke should be voting yes to the EU, when the Opposition are actively planning to renegotiate in advance of a withdrawal from the EU. I call on the right hon. Member for Devizes (Mr. Ancram), the shadow Foreign Secretary, to condemn Lady Thatcher and to withdraw the Whip from the Tory MEPs campaigning for a no vote in Estonia.

Bob Russell: Are the Government satisfied with the protection of the human rights of the Roma minorities, especially in Slovakia and the Czech Republic? Given that those countries are due to become members of the EU within the year, will he have words with his colleagues in the Home Office to stop them deporting citizens of those countries—and of others, such as Poland—who are residing in this country at the moment?

Denis MacShane: The hon. Gentleman has raised this very serious issue in other debates and we respect his concern. Our embassies and Departments such as the Department for International Development, as well as the Foreign Office, have been raising the issue. It is a serious matter. We believe that laws are in place to protect all minorities in Europe adequately, but the Roma are a special case. We will have to have special regard to ensuring that they have the same rights and enjoy the same human freedoms as all other EU citizens.

Afghanistan

Tony Cunningham: If he will make a statement on the results of his recent visit to Afghanistan.

Jack Straw: I visited Afghanistan from 30 June to 1 July. In Kabul, I met President Karzai, Foreign Minister Dr. Abdullah and Interior Minister Jalali, and saw a British Army team training NCOs of the Afghan national army. On a visit to Kandahar with Interior Minister Jalali, I spoke to a 200-strong meeting of tribal leaders and women's representatives, visited a pioneering women's health centre, and had meetings with the governor and at the police academy.
	Significant progress has been made in implementing the Bonn agreement. Security remains a key issue, as do the related issues of drugs and terrorism. Eight provincial reconstruction teams are being established, including a British-led one in Mazar-e-Sharif. For all the challenges ahead, Afghanistan is an infinitely better and safer place than when the Taliban and al-Qaeda were in control.

Tony Cunningham: I thank the Secretary of State for that reply. As chair of the all-party group on Afghanistan, I have met a great many Afghans—[Interruption.] I hope that Opposition Members will listen. All the Afghans I have met are appreciative of Britain's role in Afghanistan and are quite optimistic for the future, but my right hon. Friend is right: the key element, which they always stress to me, is security. What more can be done to deal seriously with the threat of warlords and militias?

Jack Straw: Two related things have to be done. First, the remnants of al-Qaeda and the Taliban have, bluntly, to be eliminated; they continue to pose a serious threat, especially in the south of the country, as I discussed in Kandahar with all the tribal leaders, the Afghan Administration and the US generals and the colonel in command of the forces fighting al-Qaeda.
	Alongside that, we have to build up the Afghan national army and the Afghan national police. The British Government, along with our international partners, are investing a huge amount of money and, even more important, human resources to achieve that.

Elfyn Llwyd: Following the conflict in Afghanistan, the United States Administration and the Government promised certain amounts of money towards the rebuilding of the infrastructure of that country. What was the global figure and how much has been paid?

Jack Straw: At the Tokyo conference in January last year, the United Kingdom pledged £200 million over five years, plus 19 per cent. of the European Union pledge of US $1 billion. We have spent £170 million since September 2001 and we shall continue to spend hundreds of millions of pounds in the future. Most of the money that was pledged at the January 2002 conference has been paid, although some has not. The financing requirements spelt out by the Transitional Administration are substantial. They have called for a further US $15 billion of assistance over the next 10 years and that is currently being discussed with international partners.

David Cairns: Given that 90 per cent. of the heroin on Britain's streets and three-quarters of the world's opium originate in Afghanistan, what practical and financial help and assistance can the UK Government give to the Afghan Administration to destroy this year's crop, which is currently being harvested and is predicted to be a bumper one, to ensure that that evil trade is ended once and for all?

Jack Straw: On the size of this year's crop, we shall await the results of the UN-US study. For the first time, the US and the UN agencies are using a combined methodology so that we do not end up with the huge variations in crop production that have occurred in previous years. We think that the data will be at a higher and better level.
	The Afghan Administration is devoting substantial resources to help to eliminate the crop where they can, but that is tied directly to the issue of security and terrorism. It will be a long haul, involving not only security and interdiction but the building up of alternative livelihoods for poor farmers in Afghanistan, before the too many communities in the country that depend on opium production can be moved away from that reliance.
	What are we doing? Alongside the more general training that we are providing for the Afghan national army and the Afghan police, one of the things that I saw when I was in Kandahar was a training programme, with our assistance, for a core group of good, expert police officers in the Afghan national police, so that they could deal better with drugs and drug-related crime.

Patrick Mercer: The Foreign Secretary will be aware that, in the last week of the Iraq war, there were more combat deaths in Afghanistan than in Iraq, as a result of which there has already been a considerable British reinforcement of regular troops and armoured vehicles. As a result of his visit, can the Foreign Secretary say whether he will recommend that further reinforcements go to Afghanistan?

Jack Straw: We have 300 troops in the international stabilisation and assistance force and a number of excellent troops, whom I saw, involved in other aspects of security. We are moving 60 to 70 troops, plus some Foreign and Commonwealth Office and Department for International Development officials, into the provincial reconstruction team in Mazar-e-Sharif. I have made no recommendation to my right hon. Friend the Secretary of State for Defence to increase those numbers, but he and our ambassador on the ground, in consultation with the commanders of the international security assistance force and our US colleagues, keep the number of troops, including our contribution, under very careful review.

Joan Ruddock: I congratulate my right hon. Friend on the UK role in Afghanistan, but does he not think that it is time that the United States stopped its collaboration with the warlords and made it very clear that it supports the Karzai Government? Given that a third of Afghanistan is out of bounds to UN personnel without protection and that the draft constitution has not yet been published, is it possible that the constitutional Loya Jirga can go ahead in October?

Jack Straw: I reject entirely the suggestion that the US approach is any different from ours and that it is collaborating with the warlords. It is not, and I am very clear, not least from discussions with the US commanders on the ground, that they are providing more assistance overall than any other single nation in eliminating the grip of the warlords and strengthening the power and authority of the Afghan Administration and President Karzai. Among other things, they directly provide the bodyguards for President Karzai.
	As for the Loya Jirga, I attended what amounted to a mini Loya Jirga in Kandahar, and I was impressed by the fact that a representative from the Constitutional Commission was also in attendance. An iterative, consultative process is taking place with representatives around the country. I stressed to all the Afghan representatives whom I met that it is extremely important for them that they make progress on the time lines set out by the Bonn agreement.

Burma

Mark Simmonds: If he will make a statement on relations with and possible sanctions against Burma.

Mike O'Brien: I met UN Special Envoy Razali yesterday to discuss the grave situation in Burma. The UK has repeatedly called on the Burmese military regime to release Aung San Suu Kyi immediately, as well as other National League for Democracy members who have been detained since 30 May. The Burmese military regime's response to events so far has been utterly unacceptable. The EU strengthened sanctions against the Burmese leadership on 16 June. We will ensure that pressure is put on the Burmese military regime to move towards democracy and respect for human rights.

Mark Simmonds: I thank the Minister for that answer. In the context of the Prime Minister's comments that trade with Burma is not appropriate, and Colin Powell's remarks that the time has come to turn up the pressure, exactly what further pressure are the UK Government applying, both to the EU and to the UN, to place economic strain and targeted sanctions on the military junta, not the population of Burma, to ensure the release of Aung San Suu Kyi and to provide at the very least an impetus for democratic change?

Mike O'Brien: There is considerable discussion, not only with the EU but with the United States and other international partners, including the Chinese, to find out whether we can put more pressure on the regime. In particular, we need to focus on the Association of South East Asian Nations—Burma's neighbours—as it obviously has very close relationships with Burma. We need to ensure that it sends clear messages—I am pleased to say that it has done so recently—to the Burmese regime that it must change its behaviour.
	The EU has a role to play, and it has clearly taken action itself, with bans on all defence links, high-level bilateral visits, non-humanitarian aid, supplying equipment that might be used for internal repression, an asset freeze, and a visa ban on the 153 members of the regime, their families and business associates. All that is being done, but the EU also has contacts with the various neighbours, and we need to ensure that those contacts are also used to put pressure on the Burmese regime. It is an unacceptable regime, and its unacceptability must be ended. We must move towards a process of reform as quickly as possible.

Jane Griffiths: Will my hon. Friend join me in welcoming the firm stance taken by Japan at the ASEAN meeting vis-à-vis Burma? What encouragement and support can be given to the Government of Japan, who have not always, it must be said, taken such a firm and principled stance in respect of the Burmese regime?

Mike O'Brien: We have made clear our welcome for the stance taken by Japan and also by a number of other countries in that part of the world. It is traditional in south-east Asia that countries do not criticise each other. Often, therefore, human rights issues do not get raised in the way that we would hope. However, Japan and all the other countries in south-east Asia are making it increasingly clear to the Burmese regime that Aung San Suu Kyi, who is a Nobel peace prize winner, needs to be negotiated with in a serious way, and that progress towards democracy is essential. Currently, the Burmese regime says that it is detaining Aung San Suu Kyi for her own protection—it is detaining Aung San Suu Kyi for its protection and to protect its corrupt regime, and we must ensure that that is exposed.

Richard Spring: If I may, I shall read an extract from a letter that I received this morning:
	"Really for the first time we are very worried about the safety of our sister-in-law, Daw Aung San Suu Kyi. While we obviously welcome the strong messages of condemnation from around the world, we are concerned that the only action taken has been by Japan . . . We therefore strongly endorse your argument for UN and EU sanctions, but as a first and immediate step would urge HMG to implement a British investment and travel ban."
	In that spirit, will the Government press for agreed action to be taken at the Asia-Europe meeting to be held in Bali later this month?

Mike O'Brien: I will be going to Bali later this month, and I shall certainly press the issue of Burma and the urgent need to release Aung San Suu Kyi. We are seeking to end all British investment in Burma. In particular, I have had a meeting with the chairman of British American Tobacco and have made it clear that our view is that BAT now needs to withdraw its investment in Burma. He has said that he will consider that request, and I hope to have his response in the near future.

Middle East

Helen Jackson: If he will make a statement on the middle east road map.

Jack Straw: Implementation of phase 1 of the road map is now taking place. That includes the ceasefire by Palestinian factions and the withdrawal of Israeli forces from Gaza and Bethlehem, continuing Palestinian reforms and Israeli action to dismantle settlement posts. All of those are positive first steps. Plainly, however, much more will have to be done.

Helen Jackson: Will my right hon. Friend join me in welcoming today's reports that the Palestinian Authority in Gaza are cleaning anti-Israeli graffiti and murals off the walls in that area? Does not that contrast with the continuing construction of a security wall, much of it on Palestinian land, by the Israelis? On walls in general, what is the Quartet's view as to a permanent wall playing any part in the long-term solution? What is his view on walls in that area?

Jack Straw: I have raised, as Her Majesty's ambassador in Tel Aviv has raised, with my interlocutor Silvan Shalom, the Israeli Foreign Minister, our widespread concerns in the House and in the country about the building of this security fence, particularly as it unlawfully takes in Palestinian land and cuts the Palestinians off from access to facilities that are theirs. We shall continue to press that issue. The Quartet, as far as I know, has not reached a formal position in respect of the security fence. What the Quartet is actively doing is monitoring, adjudicating and pushing the parties towards a continuous implementation of the road map. All that I would say is that given where we were even two months ago, and the terrible killings on both sides and among both communities, the progress that has been made, and the relationship built up, particularly between Abu Mazen and Prime Minister Sharon, is remarkable. We must do everything that we can to support the process.

Nicholas Soames: Given that we can all take pleasure in the fact that there is at least some progress and cautious optimism that America is at last fully engaged and genuinely determined to push forward the process, does the Foreign Secretary agree that, as in Iraq and Afghanistan, the bedrock of any solution must be security? To that end, will he determine what further efforts the British Government may make to assist the Palestinians, whose security arrangements—in many respects through no fault of their own—are not nearly good enough? Will he consider whether there are places to which assistance could be given by the police staff college and other police and military bodies to train the Palestinian police and security forces to help Abu Mazen's positive progress?

Jack Straw: I thank the hon. Gentleman for his excellent suggestions. We are already doing a lot, but I shall take those suggestions forward and write to him.

Chris Bryant: Is not the truth of the matter that the structure is not a fence or a wall but an obstacle to peace, especially because it cuts so deeply into Palestinian areas? If the fence were to be built, would it not be better if it were built on the 1967 border, in which case the Israeli Labour party, all Palestinians and the whole of Europe would probably help to build the thing?

Jack Straw: My hon. Friend makes an interesting point. The issue is not so much the fence itself—the Israeli Labour party has also proposed that—but the site of the fence and the obstacle that it puts in the way of the ordinary lives of ordinary Palestinians.

Michael Ancram: Having last week visited Israel and the west bank with my hon. Friend the Member for Rutland and Melton (Mr. Duncan), may I confirm the positive, if necessarily cautious, change of attitude to the road map on both sides? The realisation that the United States means business has opened the window to progress but, nevertheless, the road map requires difficult actions from both sides. Will the Foreign Secretary therefore join me in congratulating both Ariel Sharon and Abu Mazen on their inspiring joint press conference in Jerusalem last week and on restoring the eight ministerial joint commissions to promote agreement on local issues? Will he persuade his European colleagues to be even-handed in giving support to both sides and wholehearted in backing President Bush's bold effort to achieve a secure Israel and a viable Palestine?

Jack Straw: Of course, and as I have already done, I congratulate both leaders on really impressive statesmanship, especially when one takes account of the severe opposition that each has faced from within their own territories. The establishment of the eight ministerial commissions is important because there must be daily intercourse among Palestinians and Israelis if they are ever to live side by side in peace and security. I also tell the right hon. Gentleman, however, that the European Union has repeatedly and consistently welcomed and backed the position of the United States. It is working closely with the United States, in addition to the United Nations and the Russian Federation in the Quartet.

Michael Ancram: It was clear from my meeting with Abu Mazen a week ago that his biggest problem when controlling terrorism stems from Iranian-sponsored and directly funded support for terrorist activity in both the west bank and Israel itself. Does the Foreign Secretary agree that Iran, with its stated aim of trying to destroy Israel, poses a very real threat to the peace process, and did he raise the matter when he was in Iran last week? What steps can he take to help to halt the dangerous undermining of Abu Mazen and the road map?

Jack Straw: I did indeed raise the matter with my interlocutors when I was in Iran last week, and I pointed out that the situation is unacceptable not only because of disruption to progress toward the implementation of the road map, but because it is counterproductive for Iran. For example, progress on the trade and co-operation agreement that Iran wants with the European Union will partly be judged on whether it continues to support unacceptable rejectionist terrorist groups in Israel and the occupied territories. We continue to press, and to apply pressure on, the Iranians.

Piracy

George Foulkes: What measures the Government will take to combat piracy.

Chris Mullin: The United Kingdom is working hard for a concerted and effective approach to combat piracy. We are making progress through the UN, with political and international legal initiatives. Together with our EU partners, we have taken a lead in promoting practical co-operation against piracy.

George Foulkes: The matter is serious, as the Minister rightly implies. It is not the romantic piracy that we see on films. The problem is especially serious in African and Asian waters, where bulk carriers, containers, cargo ships, oil tankers and other vessels have been hijacked and their crews seized and terrorised. Will the Minister consider taking further action through the International Maritime Organisation and other international bodies?

Chris Mullin: My right hon. Friend is right—it is a serious issue. We work closely with international maritime organisations. The key is to ensure that countries with nationals who engage in piracy take the problem seriously. We have worked with them to ensure that they protect shipping in and adjacent to their waters. I am glad to say that recently there have been some successful prosecutions. India prosecuted 14 Indonesian pirates, who received long prison sentences. Long prison sentences were also handed out in China. Indonesia handed out prison sentences, too, although they were rather shorter than we would like. Those are examples of countries that are beginning to take the problem seriously.

Weapons of Mass Destruction

Harry Cohen: Whether the claim that Iraq could launch weapons of mass destruction within 45 minutes originated within his Department.

Jack Straw: No. The claim in the September dossier that the Iraqi military could deploy chemical and biological weapons within 45 minutes of being given an order to do so was based on intelligence material, assessed as reliable by the Joint Intelligence Committee.

Harry Cohen: Is the Select Committee right in saying that the 45-minute claim came from a single uncorroborated source, which was even wrongly quoted in the September dossier? Why was it given such prominence and by whom? Did the Foreign Secretary show a lack of discernment about that very dodgy claim, or is his responsibility for foreign security services purely nominal? Should there not be scarlet faces in Whitehall over the poor quality intelligence, poorly used?

Jack Straw: The intelligence relating to the 45 minutes was subjected to the same rigorous assessment by the Joint Intelligence Committee as all other intelligence is. There was no interference by anyone else, as the Foreign Affairs Committee acknowledged in its report yesterday.
	The 45-minute claim was given neither undue prominence in the dossier nor undue prominence in any debates or arguments that followed. If hon. Members on both sides of the House look at what they said in the House on the subject between September and March, they will find that it was scarcely mentioned. Moreover, on the best analysis of the comprehensive records available in the Foreign Office, we can find no occasion whatsoever when, in the scores and scores of interviews that I gave on Iraq over that eight-month period, I was asked one question about the 45-minute claim by any representative of the British press, TV or radio.

Menzies Campbell: But as of today, does the Foreign Secretary still believe that Iraq was capable of launching chemical and biological weapons within 45 minutes? If so, on what evidence is that based?

Jack Straw: Yes, I do. The evidence was before the House very clearly indeed on 18 March. It was overwhelmingly open-source evidence and it was clearly set out. I say to the right hon. and learned Gentleman and to the House that we need to recall that between September and November, there was the most intensive discussion internationally about whether Iraq posed a threat. Every single member country of the United Nations, including Russia, France and China, as well as the US and UK, concluded and asserted in resolution 1441 that Iraq posed a threat to international peace and security on account of its proliferation of weapons of mass destruction, its unlawful missile systems and its defiance of the will of the United Nations. It was because of Iraq's failure actively and immediately to co-operate with the inspectors that the House rightly made the decision to take military action on 18 March. It was right then and it would be right again to do so.

Malcolm Savidge: Does my right hon. Friend agree with Alastair Campbell's criticism of the BBC for reporting on the basis of a single, anonymous, uncorroborated source, and if so, should undue prominence have been given to the 45-minute deployment claim—four times in the document, including in the Prime Minister's introduction, as well as in his speech—without any indication that it was based on a single, anonymous, uncorroborated source?

Jack Straw: There was a world of difference between the source of the 45-minute claim in that JIC assessment and the source, if such it be, of Mr. Gilligan's claim. Yes, I do agree with Mr. Campbell. The BBC did get it wrong, and it should acknowledge that.

Richard Ottaway: Given the report in today's edition of the Washington Post that states:
	"The Bush administration acknowledged for the first time yesterday that President Bush should not have alleged in his State of the Union address in January that Iraq had sought to buy uranium in Africa",
	does the Foreign Secretary agree that that assertion should not have been included in the September dossier?

Jack Straw: I have not read the Washington Post this morning. I will catch up with it later. The hon. Gentleman was a member of the Foreign Affairs Committee and heard the evidence that I gave not only in public, but in private. As he well knows, the information that was included in the dossier and assessed as reliable relating to the purchase of uranium—not that Iraq had purchased it, but the fact that it had sought to purchase it—was based on sources quite separate from those based on the forged documents, about whose provenance we knew nothing until earlier this year.

Dennis Skinner: Is my right hon. Friend aware that when I voted against the Iraqi war five times, I did not vote because of 45 minutes, the right-wing BBC or any of that stuff? I voted against the war on principle, because I thought it was wrong to follow that cowboy Bush into invading another country. If that carries on, we do not know where it will stop. I have been staggered by the number of times I have read about the 45 minutes since I came out of hospital. It was not the central issue. All I would say to my right hon. Friend, and to the Prime Minister and the Cabinet, is "Next time you see that cowboy Bush walking towards you, avert your eyes and walk the other way."

Hon. Members: Welcome back!

Jack Straw: I have already, in private, welcomed my hon. Friend back, and I am delighted to do so publicly. Unlike some Members of the House and many sections of the media, my hon. Friend is not seeking to rewrite history. The idea that the argument between September and March was about the 45-minute claim is utter nonsense. My hon. Friend is entirely correct about that. I invite every Member of the House, on whichever side of the argument they were, to examine what they said, and if they can point to more than two occasions when they mentioned 45 minutes, I will ensure that they are personally given two tickets to the opening game of Burnley football club.

Michael Ancram: Is not the Foreign and Commonwealth Office the sponsoring Department of MI6 and therefore of the intelligence information provided for the relevant dossiers? When, therefore, did the Foreign Secretary first realise that the dodgy dossier was not an intelligence document, but, to coin a phrase, a horlicks? Was it before he allowed United States Secretary Colin Powell to commend it to the United Nations Security Council as "exquisite"? Was it before he allowed the Prime Minister to mislead the country by misrepresenting its status as further intelligence? If he knew that it was not an intelligence document, did he tell them so, and if, as head of the sponsoring Department, he had not been told that this was not an intelligence document, should not some heads roll?

Jack Straw: Let me make it clear to the right hon. Gentleman and the House. I have already acknowledged in round terms—[Interruption.] I am answering the questions; hon. Members should pay attention. I have already acknowledged, as my right hon. Friend the Prime Minister has done, that mistakes were made about the process relating to the document. They were wrong and we have apologised for that, but the contents of the document were accurate. The Foreign Affairs Committee at no stage challenged the accuracy of that document. Much of the document was drawn from intelligence and the Committee said that its contents were "important". As to the dates when I knew, I will write to him, but—

Douglas Hogg: And put it in the Library.

Jack Straw: I shall make it available in Hansard.
	As far as I recall, it was after the dates of the statements by Secretary Powell and, I think, my right hon. Friend the Prime Minister.

Cyprus

Andrew Dismore: When he next plans to visit Cyprus to discuss the Annan plan.

Denis MacShane: I hope to visit Cyprus in due course. The Government call on both sides to signal their intentions to negotiate on the basis of Kofi Annan's plan and to commit to putting it to referendums on both sides of the island.

Andrew Dismore: I am sure that my hon. Friend will agree that the biggest obstacle to settlement in Cyprus is the dinosaur attitude of Mr. Denktash. Does he also agree that the opening of the green line has cut away one of Mr. Denktash's prime arguments—the suggestion that Greek and Turkish Cypriots cannot get along together? We are seeing wonderful examples of people who are reconciled in facing their problems. Will he do all that he can to ensure that the people of northern Cyprus have the opportunity to express their views through the ballot box later this year in elections to the so-called Parliament in the north free of intimidation? Will he also encourage the opposition in the north to unite, so that the real feelings of the Turkish Cypriots can be expressed, in opposition to Mr. Denktash?

Denis MacShane: In addition to this oral question, my hon. Friend has tabled some 31 written questions on Cyprus that are answered today. That is a tribute to his diligent work on behalf of the interests of many of his constituents, which the House should acknowledge. He is right: it was wonderful to see the people of Cyprus voting with their feet, as it were, and brushing aside the old political thinking. I believe that they voted with their feet for a reunited Cyprus to join the European Union. We are making these points and my right hon. Friend the Foreign Secretary and I discussed them with the Turkish Foreign Minister, Mr. Gul, last week. We will continue to do so. We hope that the elections will take place in a free and fair way in northern Cyprus. Our ambition remains that a united Cyprus, on the basis of the Annan plan, will join the European Union next May.

Sydney Chapman: With Cyprus joining the European Union on 1 May next year, is it not timely for the British Government to remind the illegal regime in northern Cyprus that people there will not be able to share the benefits of joining the European Union? Would it not also be timely for the British Government to remind the Turkish Government that, if they are serious about wanting to join the European Union, they must play a much more constructive part in reunifying the island and getting rid of the green line?

Denis MacShane: Those points were made by my right hon. Friend the Foreign Secretary virtually word for word in his meeting with the Turkish Foreign Minister, Mr. Gul, last week, but there is an additional point. If a reunited Cyprus joins the European Union next May, it will make Turkish an official language of the European Union, as one of the two top figures of state in that reunited Cyprus will have to be a Turkish-speaking Cypriot. I think that that is of great advantage to Turkey as it looks forward to its candidature. That is why we hope that that can happen and think that the way forward must be to support Cyprus's EU ambitions and to put to one side the anti-European hostility that features in so much of our press in this country.

Edward O'Hara: Would my hon. Friend join me in welcoming the fact that for the next academic year the English School in Nicosia is, once again, inviting Turkish students to study with their Greek compatriots? It so happens that Rauf Denktash is an alumnus of that school. Would my hon. Friend remind the Turkish Government that the 35,000 troops who are on the island are supposed to be there to protect the interests and human rights of those very people whose voice is not being heard—the Turkish Cypriots—and that they should cleanse the electoral rolls before December to ensure that the elections are valid and give full and authentic voice to the Turkish Cypriot community?

Denis MacShane: One would have to be deaf and blind not to sense from northern Cyprus the desire to see their island reunited. I was not aware of the initiative by the school in Nicosia to offer places to Turkish students; I hope that Turkish will become used like Greek all over the island. There is still a window of opportunity. We as a Government and, I think, all hon. Members urge all the Governments in the region—we must address the Turkish Government, the Turkish Parliament and the Turkish military—to recognise the fact that this is a golden moment to seize. It will be good for Turkey, good for Cyprus and good for the eastern Mediterranean if a united Cyprus can enter the EU next May.

Iraq

Cheryl Gillan: When he last met representatives of the US Administration to discuss Iraq.

Jack Straw: On 27 June, I met National Security Adviser Condoleezza Rice in London, and on 2 July I met ambassador Paul Bremer, who heads up the coalition provisional authority in Baghdad. On Sunday, I discussed Iraq with Secretary Powell on the telephone. The House will wish to know that the first meeting of the new Baghdad city council took place yesterday. The 37 members of that council were chosen from among the members of the 88 neighbourhood advisory councils of Baghdad. With the launch last week of the Basra city council, every major Iraqi city now has its own local government.

Cheryl Gillan: It is a shame that the Foreign Secretary did not have a chance to meet Senator Richard Lugar, who chairs the Foreign Relations Committee, and who, after visiting Iraq last week, said:
	"This idea that we will be in"—
	Iraq—
	"for just as long as we need to and not a day more . . . is rubbish . . . We must reorganise our military to be there a long time."
	Is not that latest American assessment rather closer to the truth than what the Prime Minister and the Foreign Secretary say on the subject; and do we not face a similar situation to that in Bosnia, where British troops are still deployed after 11 long years?

Jack Straw: Frankly, I do not see a huge distinction between the comments of Senator Richard Lugar, whom I know and greatly respect, and what the Prime Minister and I have said. We all recognise that we have a long-term commitment to security in Iraq, but we also have to recognise the importance of reducing our presence, then leaving Iraq altogether as soon as the security situation allows and the Iraqi people wish it.

Mike Gapes: Will my right hon. Friend confirm that for many of us the decision to go into Iraq was a question of a choice between the failed policy of containment and the historic opportunity to liberate the Iraqi people from fascist tyranny; and that we in this country who made that choice will know over the next decades that it was right? Does he agree that just as the countries of central and eastern Europe that are now coming into the European Union were liberated by various means, and Germany and Poland were liberated from Nazi tyranny many years ago, we can be proud today that in the long historic sweep ahead of us we will have made a contribution to democracy and freedom for Muslims and Arabs in Iraq and throughout the region?

Jack Straw: Yes, I do accept that. The key question for everybody, not least those who, for reasons that I understand, opposed the war, is to ask what condition that region and international peace and security would now be in if, in the face of that defiance of the will of the United Nations, we and the US had walked away. I shall tell hon. Members what the position would be. Saddam Hussein would have been re-empowered and re-emboldened. He would have increased the terror in his country and acted with even greater thoroughness to increase his chemical and biological capabilities and develop his nuclear capabilities. He would have continued to disrupt any chance of an effective peace process between Israel and the Palestinians, and increased the threat that he posed to international peace and security. That is the truth and I look forward to newspapers debating that rather than their extraordinary obsession with 45 minutes.

Alan Duncan: At the St. Petersburg summit, the Prime Minister made much of his exclusive interview with Sky's Adam Boulton to announce, doubtless ever so sincerely, that evidence of the existence of weapons of mass destruction in Iraq would be assembled and given to people.
	He said,
	"just wait and have a little patience".
	Now that the Foreign Secretary has been promoted and is, since yesterday, Alastair Campbell's official spokesman, will he tell us what evidence has been accumulated, how much longer we must wait and how much more patience we shall need?

Dennis Skinner: Why did you vote for the war then?

Jack Straw: My hon. Friend the Member for Bolsover (Mr. Skinner) asks a pertinent question. [Interruption.] I shall answer the question of the hon. Member for Rutland and Melton (Mr. Duncan), but, after languishing for 18 years in opposition, I shall also offer the Opposition gratis advice: it would be unwise for them and their reputation if they started to rewrite history, as they are trying to do.
	The Iraq survey group has been established and is carrying out its work. Neither my right hon. Friend the Prime Minister nor I can say how long it will take. It will take as long as it takes. However, if the hon. Gentleman has any doubts about whether he made the correct decision on 18 March, I commend to him all 173 pages of the United Nations Monitoring, Verification and Inspection Commission's last report on unanswered disarmament questions. It sets out in horrifying detail Iraq's failure to answer questions about the whereabouts and capabilities of chemical and biological weapons. That was the truth, and the document, from an entirely independent source, was one of the main considerations in the minds of hon. Members when they carried the vote with a large majority on 18 March.

Jon Owen Jones: Although the Foreign Secretary is correct in saying that we need more time to look for weapons of mass destruction, the Government could usefully make some interim statements. For example, how long does it take to find whether a nuclear programme and undiscovered nuclear reactors exist? How long does it take to find a chemical factory? The Government could usefully make some initial decisions and determinations now so that we were at least in a better position to know what weapons of mass destruction Iraq did not have even if we do not know what weapons it had.

Jack Straw: First, parts of the September document that we published have already been proved true. They include the parts that relate to the shorter-range missile systems and the import of far larger quantities of missile engines than Iraq ever conceded. Indeed, it failed to admit to them when it was forced to make its second set of disclosures on 9 December. I can recall no claim that Iraq had built a nuclear reactor, so my hon. Friend should not invent claims to knock them down.
	It is in our interests as much as those of anyone else to continue the search. However, given the reign of terror, the destruction and looting that unfortunately took place during and immediately after the war, and our knowledge of Iraq's continued efforts at concealment, which the dossier pointed out, the task will be difficult and painstaking. I remind those who would make glib assumptions that, 30 years on, we still do not know the whereabouts of IRA arms dumps, despite the fact that we know the country far better and that our intelligence penetrated it far more successfully than we have ever been able to penetrate Iraq.

Patrick Cormack: I agree with what the Foreign Secretary has just said. Does he accept that many who voted as they did on 18 March, and have no regrets, believe that we should not spend more than another 45 minutes on the nauseating nitpicking that has been going on recently?

Jack Straw: I am grateful to the hon. Gentleman. I am in no doubt about that, I know that he is in no doubt about it, and I see from the nods all around him that a large number of Conservative Back Benchers, at least, take the same view. I hope that their advice is passed to the Front Bench, because the Conservative party, which has an honourable history, will simply be a part of history if it tries to rewrite it.

European Constitution

Graham Allen: If he will consult people in Nottingham, North on amendment of the draft European Constitution.

Denis MacShane: I intend to visit Nottingham later this year as part of a programme of UK visits to raise awareness of EU enlargement. This will include discussion of the draft constitution, which proposes reform and modernisation of the EU to ensure that it can continue to function effectively following enlargement.

Graham Allen: Does my hon. Friend realise that the people of Nottingham, North—indeed, the constituents of all Members—can be involved in the consultation, as can all Members themselves, if he allows pre-legislative scrutiny of the European constitution before it goes to the intergovernmental conference? It is vital for Members to be involved before and not after decisions are made. I welcomed the letter I received from the Foreign Secretary saying that he would consider the matter, and hope that in tomorrow's debate he will be able to reassure us that we and our constituents can have a serious input in the IGC before everything is cut and dried.

Denis MacShane: My hon. Friend is right. I am grateful to him for his practical suggestions, as is my right hon. Friend the Foreign Secretary. The Foreign Office has set up an interactive website, futureofeurope@fco.gov.uk, to allow communication via e-mail.
	We have had seven debates on the convention and the future constitutional treaty, and there will be another tomorrow in Government time. My right hon. Friend the Foreign Secretary will publish command papers on the subject, and I am visiting more than 100 UK towns and cities where these issues are, of course, discussed.
	Conservative Front Benchers laugh. I suggest that if they occasionally listened to the voters of this country, they might learn where their disappearing support has gone.

Angus Robertson: I am sure that, as part of the consultation process, the Minister will pay close attention to the reports of the European Scrutiny Committee. May I recommend its recent report entitled "The Convention on the Future of Europe and the Role of National Parliaments"? Paragraph 55 states:
	"We are concerned about the prospect of exclusive EU competence in the 'Conservation of marine biological resources under the common fisheries policy' and how this might affect the management of marine resources at all levels."
	May I strongly urge the Minister and the Government to consider that concern and act on it during the intergovernmental conference?

Denis MacShane: The hon. Gentleman is a doughty defender of the fishing interests of his constituents, but he is right to draw attention to the fact that under the constitutional treaty there is a strengthened role for national Parliaments. It is important that they should play a central part.
	Let me quote from Hansard:
	"It is indispensable to our system of government that Parliament should play its full part in all the important acts of state".—[Official Report, 8 December 1941; Vol. 376, c. 1358.]
	That was said by Winston Churchill. In those days, the Conservative party was led by someone who believed in defending the rights of this House, not in surrendering them to the Rothermere press so that it could dictate policy.

Illegal Arms Trade

Jim Cunningham: What consultations he has had with ministerial colleagues regarding Europe-wide efforts to prevent the illegal arms trade.

Bill Rammell: My right hon. Friend the Foreign Secretary recently discussed this issue with his counterparts in the General Affairs and External Relations Council of the European Union—a discussion that led to the adoption of the basic principles for an EU strategy against the proliferation of weapons of mass destruction on 16 June 2003.

Jim Cunningham: I thank my hon. Friend for that answer. Given that he has just outlined an EU strategy, what role would Interpol play in catching arms smugglers?

Bill Rammell: The EU will work through this process in co-operation with Interpol. We have one of the toughest, most open and accountable export licensing regimes in the world, but it is critical that we transplant that on a multilateral basis, which is why we should engage through the EU.

Several hon. Members: rose—

Mr. Speaker: Order. I point out to the House that we only reached Question 10 today, and it is unfair to those who have taken the trouble to table questions that they are not being called. It would assist me in future if both questions and answers were far briefer, so that we can get further down the Order Paper.

Points of Order

Tim Boswell: On a point of order, Mr. Speaker. I know that you are always anxious to ensure that Ministers make their announcements first to the House. Yet on making inquiries about tomorrow's launch of the Government's national skills strategy, I discovered from the Department for Education and Skills that although the Secretary of State will indeed seek to make a statement to the House at 12.30 pm tomorrow, he intends meanwhile to visit Westminster further education college, in the company of the Secretary of State for Trade and Industry, for a launch breakfast.
	You will know, Mr. Speaker, that I yield to no one in my support for FE colleges as a whole—and, indeed, for that college in particular—and I have absolutely no objection to the Secretary of State for Education and Skills having breakfast. But with great respect, an FE college is not the House of Commons, and I wonder whether you would care to request that the Secretary of State make his initial statement here—perhaps, for example, by seeking to intervene in today's debate at 7 pm.

Mr. Speaker: Like the hon. Gentleman, I have no objection to the Secretary of State having breakfast, but I will look into the matter and write to the hon. Gentleman.

Eleanor Laing: On a point of order, Mr. Speaker. You will be well aware of the contents of early-day motion 1548, concerning the Minister for Children. It has been made public that the Minister intends to address a conference this afternoon on the subject of the Green Paper on children at risk. Have you had any indication that she intends to do us the courtesy of coming to this House—as you have so often told Ministers they ought to—to present the Government's plans on this urgent matter, before presenting them elsewhere?

Mr. Speaker: I have seen the terms of the early-day motion and the hon. Lady's point of order really has nothing to do with me: the early-day motion is in perfectly good order. The hon. Lady put an urgent question to me that was rejected, and I give no reason as to why it was rejected. I have looked into the question of whether the Minister for Children will speak at the conference about the Green Paper on children's rights, and I understand that she will not; rather, she will speak in her capacity as a Minister, which she is entitled to do.

House of Lords (Exclusion of Hereditary Peers)

David Winnick: I beg to move,
	That leave be given to bring in a Bill to repeal section 2 of the House of Lords Act 1999.
	As we know, the Prime Minister and the then Conservative leader in the House of Lords reached a compromise whereby most of the hereditary peers would go and 92 would remain. That agreement cost the then Tory leader in the House of Lords his job; nevertheless, it formed the core of the House of Lords Act 1999, which contains the exemption that I am hoping to change.
	On 11 November 1999, I went along to the House of Lords with several hon. Friends to watch an historic occasion in which more than 640 hereditary peers were to leave the House of Lords. I am glad that I went to watch those proceedings on the final part of what became the law of the land.
	The purpose of the modest measure to which I am speaking today is that the remaining 92 hereditary peers should also go. It is now nearly four years since the rest went. I should point out that, had there been no change of Government in 1997, no change whatever would have taken place. The only reason for the departure of most hereditary peers is that Labour carried out its election manifesto. When I examined the Conservative manifesto for 1997, I found that, far from proposing any change to the regime of hereditary peers, it strongly opposed what it described as
	"Labour's extremely damaging proposals on Lords reform".
	Clearly, without the Labour Government, all hereditary peers would have stayed for a long time to come. Those who recall the debates on the House of Lords Bill 1999 in the House of Commons will also remember the strong opposition that came from the Conservative Benches. There was certainly no enthusiasm, to say the least, and at the end of the day the Conservatives tabled what could be described as a wrecking amendment.
	I realise that the remaining 92 hereditary peers were to be kept in place until further reform of the Lords took place, but my point today is that, regardless of the various conflicting views about the composition of the House of Lords—whether it should be elected, appointed or, as I personally prefer, a combination of the two—the time has come for no hereditary peers whatever to sit in the House of Lords. I want to make it clear that I have no personal antagonism towards the remaining peers; there is no reason why I should. On some occasions, on measures such as hunting with dogs, we know that hereditary peers will vote in a certain way, but my concern today is the basic principle that, in a democracy—and certainly in the 21st century—no one should have a seat in Parliament simply because their ancestors were, for whatever reason, given a title.
	I found out when some of the titles were created. Some were conferred about 60 or 70 years ago. Several were conferred in the 19th century: some peers sit in the House of Lords because their ancestors were given a title in 1801, 1815, 1821, 1869, 1828 and 1841. Yet they can be considered relatively recent. If we continue to examine the list, we find that some who sit in the House of Lords have titles going back to 1605, 1609, 1620, 1633 and 1660. Other titles date from the 18th century—1707, 1711, 1728. That goes back some distance, but the list goes back even further. I found that one peer sits in the House of Lords on the basis of a title created in the 16th century; six on the basis of titles created in the 15th century; and two on the basis of titles created in the 14th century. It does not even end there, because one peer's title was created in 1283—28 June 1283, to give the exact date.

Patrick Cormack: He's Labour!

David Winnick: Whether a hereditary peer is Labour, Conservative or Liberal—I remind the hon. Gentleman who has just shouted across the Floor of the House that I have already said that it is nothing personal—their remaining in Parliament because of titles created as long ago as 1283, or in the 14th and 15th century, makes no sense whatever.
	We rid Parliament of more than 640 hereditary peers four years ago, and I do not notice any enthusiasm among the Tories for the restoration of the hereditary principle. They refused to support what was done four years ago, and described Labour's proposals as "damaging", but they now—as far as I know—accept the status quo. When the remaining hereditary peers go, there will be no desire to bring them back.
	As I argued earlier, this is a modest measure. The work has been left undone, and it is now time to rid Parliament of those who sit here simply because their ancestors were given a title.

Douglas Hogg: I rise to oppose the Bill, but before I do so I should declare a couple of interests. The first is that my wife is a member of the other place and the second is that, but for legislation that the House has passed, I would have been entitled to sit in the other place. I must add that I would not have done so, because I much preferred to stay in this House.
	All my political life I have campaigned for substantial reform of the House of Lords. I believe in a House of Lords that is elected or largely elected. I am opposed to its appointed form and to the hereditaries. My reason for seeking an elected Chamber is that I want to increase the powers of the second Chamber substantially. I recognise that the only basis on which one can give the second Chamber real power is if it is given legitimacy. In the modern world, election is the only basis for political legitimacy. One of my great regrets is that the Conservative Government of which I was a member for many years did not tackle the problem of House of Lords reform.
	My objection to the Bill is twofold. First, most of us would agree that the hereditaries in the other place are independent-minded and unpredictable. Both of those are good characteristics. The hereditaries are also wholly unwhippable. I welcome unwhippable members of the House of Commons or of the House of Lords. I want to see thoroughly unwhippable and unwhipped Members of Parliament. [Interruption.] Well, I am thoroughly unwhipped, as my hon. Friends know full well, but that is not my main point.
	I actually agree with the hon. Member for Walsall, North (David Winnick) that the presence of the hereditaries is an anomaly and cannot be justified. However, as long as the anomaly exists, so will the pressure for reform. The converse is true: if the hereditaries were taken away, the Prime Minister would have what he wants, which is a wholly appointed House that lacks legitimacy. The Bill would create a wholly appointed second Chamber, and the pressure for reform would die away. I regard that as undesirable.

Patrick Cormack: Will my right hon. and learned Friend give way?

Douglas Hogg: I am pleased to give way to my hon. Friend.

Patrick Cormack: rose—

Mr. Speaker: Order. There can be no interventions in a ten-minute Bill.

Douglas Hogg: My hon. Friend told me that he had a very good intervention to make, and I am sure that he does.

Patrick Cormack: On a point of order, Mr. Speaker.

Mr. Speaker: I shall take the hon. Gentleman's point of order after the right hon. and learned Member for Sleaford and North Hykeham (Mr. Hogg) has finished.

Douglas Hogg: Mr. Speaker, I am sorry that, between us, my hon. Friend and I cannot encourage you to allow his intervention.
	In summary, I believe in a thoroughgoing reform of the House of Lords, and that the hereditaries are an anomaly. So long as they are there, there will be constant pressure for change, and if we take them away as the Bill proposes, the pressure for change will die away. We would then have a wholly appointed Chamber, which would lack political legitimacy. That is what the Prime Minister wants, but it is not what we should want. On that basis, I invite the House to oppose the Bill.
	Question put, pursuant to Standing Order No. 23 (Motions for leave to bring in Bills and nomination of Select Committees at commencement of public business):—
	The House proceeded to a Division.

Mr. Speaker: I ask the Serjeant at Arms to investigate the delay in the Aye Lobby.

The House having divided: Ayes 171, Noes 73.

Question accordingly agreed to.
	Bill ordered to be brought in by Mr. David Winnick, Angela Eagle, John Cryer, Andrew Mackinlay, Mr. Marsha Singh, Mr. Khalid Mahmood, Mr. John Battle, Ms Candy Atherton, Rob Marris, Mrs. Alice Mahon, Ian Lucas and Mr. John Smith.

House of Lords (Exclusion of Hereditary Peers) Bill

Mr. David Winnick accordingly presented a Bill to repeal section 2 of the House of Lords Act 1992: And the same was read the First time; and ordered to be read a Second time on Friday 11 July, and to be printed [Bill 144]. WELSH GRAND COMMITTEE
	Ordered,
	That—
	(a) the matter of the Draft Public Audit (Wales) Bill be referred to the Welsh Grand Committee for its consideration;
	(b) the Committee shall meet at Westminster on Tuesday 15th July at five minutes to Nine o'clock to consider the matter of the Draft Public Audit (Wales) Bill under Standing Order No. 107 (Welsh Grand Committee (matters relating exclusively to Wales)).—[Mr. Coaker.]

Health and Social Care (Community Health and Standards) Bill (Programme) (No. 2)

John Hutton: I beg to move,
	That,
	(1) Paragraphs 4 and 5 of the Programme Order of 7th May 2003 relating to the Health and Social Care (Community Health and Standards) Bill shall be omitted.
	(2) Proceedings on consideration shall be taken in the order shown in the following table, and each part of the proceedings shall (so far as not previously concluded) be brought to a conclusion at the time specified in the second column.
	
		TABLE
		
			 Proceedings Time for conclusion ofproceedings 
			 Amendments relating to Clauses in Part 1; New Clauses relating to Part 1; new Schedules relating to Part 1; amendments relating to Schedules 1 to 4. 3¼ hours after the commencement of proceedings on the motion for this Order. 
			 New Clauses relating to Part 2; amendments relating to Clauses in Part 2; new Schedules relating to Part 2; amendments relating to Schedules 5 to 8. 4¾ hours after the commencement of those proceedings. 
			 New Clauses relating to Part 4; amendments relating to Clauses in Part 4; new Schedules relating to Part 4; amendments relating to Schedule 10. 6½ hours after the commencement of those proceedings. 
			 New Clauses relating to Part 3; amendments relating to Clauses in Part 3; new Schedules relating to Part 3; amendments relating to Schedule 9; New Clauses relating to Part 5; amendments relating to Clauses in Part 5; new Schedules relating to Part 5; amendments relating to Schedules 11 and 12; New Clauses relating to Part 6; amendments relating to Clauses in Part 6; new Schedules relating to Part 6; amendments relating to Schedule 13; remaining New Clauses and new Schedules; remaining proceedings on consideration. 7 hours after the commencement of those proceedings. 
		
	
	(3) Proceedings on Third Reading shall (so far as not previously concluded) be brought to a conclusion 8 hours after the commencement of proceedings on the motion for this Order.

Hon. Members: Hooray!

John Hutton: I think that those are probably the only cheers that I will get this afternoon.
	We have drafted the programme motion in an attempt to be fair to all sides of the House. The amendments selected for debate today concentrate largely on part 1 of the Bill. That is why the motion devotes the lion's share of the House's time this afternoon to consideration of those amendments.
	Clearly, the rest of the Bill is no less important. I hope that the House will find the divisions that we propose acceptable. We have allowed one and three quarter hours for debate of the new GP contract clauses. Many hon. Members will know that the contract is the result of two years of negotiations between the NHS Confederation and the British Medical Association. The clauses make the changes to the primary legislation that will allow us to make the new contract a reality. It may help the House if I explain that both the NHS Confederation and the chairman of the BMA's general practitioners committee, Dr. John Chisholm, have indicated to me their support for the Government's amendments.
	Aside from the GP contract clauses, the Government's amendments are intended—

Patrick Cormack: I am extremely grateful to the Minister for giving way, but does he think that those eminent doctors will be satisfied with what they took two years to decide being disposed of by the House in less than two hours?

John Hutton: Given the very high quality of the debate that we will have on that part of the Bill, I have no doubt that they will be perfectly satisfied with an hour and three quarters. I hold the hon. Gentleman in high regard, and I do not want to minimise the point that he makes, as the provisions are very important. I refer to the agreement on these clauses that we have reached with the confederation and the BMA simply to try and reassure hon. Members that the Government's proposals command widespread support in the NHS. I hope that the House will find that helpful.

Andrew Lansley: The Bill provides that much of the detail in it may be prescribed in regulations. The Minister will understand that that has relevance for the amount of time being allocated for debate. To what extent will those regulations be subject to debate in the House, under the affirmative resolution procedure? That such debates will be required is obvious not from the structure of the new clauses themselves, but from reference to previous legislation.

John Hutton: The regulations will be passed under the negative resolution procedure. I am sure that the hon. Gentleman will want to raise that point in the debate, and that the matter will arise in another place. However, the proposed format is the one used in the existing legislation for the regulations concerning the general medical service contracts, and we are not suggesting that the new proposals receive any less parliamentary scrutiny in this place. Last week, we circulated a set of explanatory notes and information about how the regulation-making powers are intended to be exercised. I hope that the hon. Gentleman and other hon. Members have found that helpful.
	This part of the Bill deals with primary care services and, as usual, looks fiendishly complicated. However, the Government are proposing a simplified and more streamlined system for implementing the GMS contract. A smaller volume of secondary legislation will be needed to underpin it. That is one of the principles that we have adopted in framing the provisions.
	The programme motion also provides an hour for the Third Reading debate. I believe that it is a fair and balanced attempt to ensure that the House has appropriate opportunity to consider the amended Bill properly. I hope that the House will support the motion.

Liam Fox: The Minister's opening statement that the programme motion has been drafted in an attempt to be fair to all sides of the House gives us a good indication of what the Government's definition of "fairness" is. Before today's debate, 60 clauses had not even been considered in Committee. A total of seven hours for debate today is an insult to the House, in terms of the sheer volume of amendments that we might have to consider. There are 250 amendments and new clauses in the first group selected for debate, Mr. Speaker. I do not know whether you can recall a Bill with that sheer volume of amendments and new clauses, but I doubt that there has been one that has been guillotined to this degree.
	Thus, in an extremely short time, we have to consider the whole issue of foundation hospitals, their complexity, their borrowing rights, the role of the regulator, cross-border matters, terms and conditions of service, asset disposal, governance, the role of centrally determined targets, the effects of creating a two-tier system, the interface with the private sector, the cost of maintaining a foundation hospital board and the complexity of the electoral process—and that is just the first group. We then get to the complaints procedure, standards for health and social care—another hugely important issue—provision in cross-border areas and the regulation of social care services, including those for children.
	We shall then have one and three quarter hours to debate the whole of the contract that will shape the future of primary care—the whole of it. Until now, we have had no chance, during the whole passage of the Bill, to debate that matter. That shows the importance that the Government accord the whole issue of the forward path for primary care—one and three quarter hours.
	We then have to deal with NHS charges and welfare food schemes. To try to squeeze all that and a Third Reading into the time on offer is hugely offensive to many Members; they may hold differing opinions on the issues, but they believe none the less that the House should be given appropriate time so that every voice can be heard.
	To add insult to injury, leading the debate for the Government is a Secretary of State who represents a Scottish constituency. He will be trying to push forward measures in England that he will not be forcing through for his constituents in Scotland, using up debating time in this place. Furthermore, the Bill will be backed and voted for by Members representing Scottish and Welsh constituencies who have no say on health in their own constituencies but will be trying to apply these measures to voters in England.

Roy Beggs: The hon. Gentleman may not have noticed that Northern Ireland is also represented in the House and that we try to play our part in United Kingdom business. Will he accept that although we would like to play a full part, that is being denied us today, because the Northern Ireland Grand Committee is sitting while this important measure is being debated in the Chamber?

Liam Fox: That is an important point and I am sure that you will have taken note of it, Mr. Speaker, on behalf of the smaller parties that would like to have their say.
	The whole debate is an insult to patients in England; it is an insult to the House itself. The contempt it reveals in the Prime Minister's regard for the House shows that the House of Commons has become little more than Downing street in Parliament.

Michael Weir: I shall be relatively brief, as I do not want to eat into the time.
	We in the Scottish National party and Plaid Cymru also oppose the programme motion, but for different reasons. The hon. Member for Woodspring (Dr. Fox) said that the measure does not impact on Scotland and Wales; indeed, this morning, I heard an hon. Member say on the radio that the Scots should keep their noses out of English business. In fact, however, significant parts of the Bill will directly affect Scotland and significant parts will have secondary effects in Scotland, including the provisions on foundation hospitals.
	We believe that much more time is needed to debate the full implications of the establishment of foundation hospitals in England for health service provision in both Scotland and Wales. For example, the programme motion could give as little as two and a half hours fully to debate the implications of foundation hospitals, and although clause 1 states that foundation hospitals will be only in England, there is increasing concern in both Scotland and Wales that there could be severe knock-on effects on health service provision owing to the operation of the Barnett formula.
	Scottish and Welsh health care is funded from the block grant, which is driven by Barnett consequentials, based on English funding for services devolved to Scotland and Wales. Although the Scottish Executive and the Welsh Government decide what proportion of the block is spent on health care, the extent to which the size of the overall block is affected may affect the choices open to them.
	We do not believe that the timetable motion gives enough time for a full debate on that issue. Wider debate, involving the Treasury as well as the Department of Health, is required on the whole funding issue.

Martin Smyth: Ours is a national health service and the whole kingdom has been proud of it over the years. Because there is movement across borders, it is important that we look at the measure in greater depth than is proposed today.

Michael Weir: I accept the hon. Gentleman's point. The proposals for foundation hospitals give rise to serious issues that affect Scotland, Wales and Northern Ireland. For those reasons, we need more time to debate the measure both on Report and on Third Reading than has been provided under the programme motion, so we oppose it.

Richard Taylor: As one of the unwhippable Members to whom the right hon. and learned Member for Sleaford and North Hykeham (Mr. Hogg) referred, I speak on behalf of many ordinary people who are amazed and concerned that we are given only eight hours to discuss this extremely important Bill. Other right hon. and hon. Members have pointed out the limited number of hours for each item.
	What makes it worse is that we have been presented with so much new information in the last 24 hours. The paper on the GP contract has 53 pages. The response to the Select Committee on Health report on foundation trusts, which amazingly came out only yesterday, two months after the report was published, contains a further 30 pages. The Bill is so vast that only a small proportion of it will be covered today.
	May I remind the House of an old proverb? My book claims that it is an English proverb, but it would be close to the hearts of Scottish people, too. It is:
	"Wilful waste makes woeful want."
	Wilful waste of parliamentary time on less important issues has led to a woeful want of time to debate all the vital issues raised by the Bill.

Evan Harris: I have some sympathy for the remarks of the hon. Member for Woodspring (Dr. Fox) about the consequences of devolution, but I have complete sympathy with, and subscribe wholeheartedly to, the rest of his views on the programme motion.
	Part of the reason for our despair at the short time for the debate is that it is difficult to hold a proper and wide debate in Committee of issues such as foundation trusts when none of the Committee's members share the strongly held views of the Labour Members who have tabled so many of the amendments. All their concerns have to be expressed and all their points made on Report, where time is always limited, rather than in Committee. Even so, it seems astonishing that such a Bill should be allocated only one day on Report. Indeed, when I heard that the new proposals on the GP contract would be dealt with only on Report I thought that we should need three days rather than two, so to find that only one day had been provided was a bitter disappointment, not only to those of us, on both sides of the House, who want to scrutinise the Government's proposals, but also to our electors who expect us to do that job.
	The part of the Bill that deals with the future and independence of the quality inspectorate is even more important than the provisions on foundation hospitals. Despite representations from the Liberal Democrats in the Standing Committee and in the Programming Sub-Committee, we did not reach many of those clauses in Committee, even though, compared with other Committees on which I have served, we made brisk progress. Indeed, a whole section on the social services inspectorate was not covered at all. Under the timetable, it is extremely unlikely that we shall reach the clauses on the inspection of children's services and social care.

John Bercow: Given that there is no desperate urgency about the passage of the Bill, and that the programme motion provides for less than one minute to be devoted to debate on each new clause and amendment relating to foundation hospitals, can the hon. Gentleman think of any reason for the programme motion other than a desire on the part of the Government to limit to an absolute minimum the opportunity for their Back Benchers to excoriate them?

Evan Harris: The hon. Gentleman's suggestion is the favourite runner. There may be other reasons, but I have heard none more persuasive.
	The new clauses on the GP contract are also of concern. Presumably, they were prepared on the assumption that GPs would support a contract that they had negotiated, before the realisation that someone had got their sums wrong so the contracts would have to be renegotiated and the ballot postponed. One has to ask why we were presented with the new clauses on the Order Paper only yesterday and why, uniquely, a letter dated 3 July and sent to hon. Members by internal post arrived only yesterday. That is a technique that many students use with the essays; they date them long before they post them.
	I should have thought that we would be given more time to consider such serious issues and to suggest amendments. Indeed, the only amendment that has been selected to those new clauses is, of necessity, starred. I suppose that I am grateful that it has been selected at all, but hon. Members have not been given time to consider those new clauses. In effect, we will have no real scrutiny of those new clauses.
	The Government have to understand that the impact of our failure to give proper scrutiny to those new clauses in this House makes it much more likely not only that the other House will despair of the ability of this House to hold the Executive to account, but that the Lords will feel it incumbent on them to do so, and I would support them if they considered that factor.
	If we could debate and divide on some of those measures, the Government's objection to being held up in the House of Lords might have more merit, but their failure to provide the House with the ability to scrutinise gives more power to the arm of those in the House of Lords who desire to ensure that adequate scrutiny takes place. So I join the hon. Member for Woodspring in being appalled at the short time that we have been given to debate these serious matters.

Patrick Cormack: I do not always agree with the hon. Member for Oxford, West and Abingdon (Dr. Harris), but I agree with everything that he said in his brief speech. I am appalled that we have such a short time to debate the Bill, and I would have hoped that the Secretary of State for Health would be appalled too. He was beginning to show the House that he was a robust defender of the House's privileges, when he was Leader of the House, all too briefly. He was beginning to show the House that he understood the importance of holding the Government to account. He was beginning to show the House that he really believed that legislation should be properly scrutinised and thoroughly debated before passing on to the statute books. He was beginning to show the House that he thought that this House, as well as the House of Lords—the other place—should debate things thoroughly, with care and diligence.
	After 10 short weeks, the right hon. Gentleman was translated into a new job, and he seems to have forgotten all the principles that he was beginning so impressively to embrace. I find that deeply distressing because he is now party to an exercise that is an insult to each of our constituents—frankly, Mr. Speaker, it is an insult to you too—because the House is not being given an adequate opportunity to debate a measure that directly or indirectly affects the lives of each of our constituents. That is monstrous. The Government's distortion of priorities is shown by the fact that, just over a week ago, we spent a whole day on fox hunting, time which could have been devoted far more properly and profitably to this measure, which touches the lives of our constituents far more than fox hunting does.

Peter Luff: Does my hon. Friend share my concern that today's hypocrisy may be considerable? The scent of the blood of a ban on fox hunting may be still in Labour Members' nostrils to such an extent that they think that they can reduce opposition to foundation hospitals and squeeze the proposal through. In fact, the link that he makes between fox hunting and today's proceedings could be considerable and very cynical indeed.

Patrick Cormack: Oh yes, of course, we all know that almost everyone has his or her price, but I do not have one, and I am most anxious to ensure that, once again, the House is regarded throughout the country as the place where the nation's affairs and the legislation that touches the lives of its people are thoroughly and properly debated. We are now in an era of the compulsory guillotine. Every measure brought before us—there are far too many of them—is put in the straitjacket of a timetable, and hon. Members are not given an opportunity for debate.
	This happens to be an issue where many Labour Members have honourable differences with their Government. Frankly, I am rather inclined to agree with the Government, rather than those Labour Members, but the fact is that the issues that they would raise are important and far reaching and they deserve very thorough debate; but hon. Members will not have the opportunity to take part in those debates. That is a monstrous affront to the parliamentary integrity of this country, and the Secretary of State should be thoroughly ashamed of himself.

Edward Garnier: I want briefly to agree with my hon. Friend the Member for South Staffordshire (Sir Patrick Cormack), but I want to express a slight note of disagreement with the hon. Member for Oxford, West and Abingdon (Dr. Harris), who expressed surprise that the Government had introduced the timetable motion. Over the past few years, the one thing that we have not needed to be surprised about is the Government's willingness to guillotine and closely schedule debates either on the Floor of the House or in Committee. Although I agree with the general thrust of his argument, surprise is not an emotion that washes over me this afternoon.
	I wholeheartedly agree, however, with my hon. Friends the Members for Woodspring (Dr. Fox) and for South Staffordshire and with the hon. Gentleman, and I worry at times that the Government have completely lost sight of what they are for and what Parliament is for. We all agree that, by and large, a Government who are elected with a large majority are entitled to get their business through the House. We also accept that, on free vote issues—I understand that this is not a free vote issue—the will of the House of Commons is entitled to have its way, but if we are to admire democracy to that extent, we fool ourselves if we suborn the process.
	I fear that the Government are guilty of suborning the democratic process, and a democratic process that is only that in name is no democracy at all. Hardly a day goes by now without some sort of timetable motion being put to the House by the Government, as though it were a matter of real choice. It is not a matter of real choice; it is thought up in No. 12 Downing street by the Chief Whip and the other business managers. It is imposed on the relevant Secretary of State or junior Minister who has to carry that business, and it is then imposed on the House by a compliant and suborned majority. The longer the Government go on like that, the more they will resemble the Government of the current president of Zimbabwe. [Interruption.] Those groans speak volumes, and the right hon. Member for Birkenhead (Mr. Field) and I have our differences with the Government over their handling of pensions issues, debate on which they have crushed by using timetabling. Our political views differ on a whole host of things, but both of us, as democrats, share an understanding that the need to respect the process of democracy is every bit as important as the right of a Government with a majority to get their business through the House.
	We can bleat about the Government's role in this timetable motion—I will continue to bleat as often as I possibly can, even though I am entirely powerless—but eventually hubris will overtake the Government, and eventually the public will have their say and the guillotine will be of a rather different nature.

Question put:—
	The House divided: Ayes 314, Noes 164.

Question accordingly agreed to.

Orders of the Day

Health and Social Care (Community Health and Standards) Bill

As amended in the Standing Committee, considered.

Clause 1
	 — 
	NHS Foundation Trusts

David Hinchliffe: I beg to move amendment No. 164, in page 1, line 4, leave out clause 1.

Mr. Deputy Speaker: With this it will be convenient to discuss the following:
	Amendment No. 60, in page 1, line 7, at end insert 'and Wales'.
	Amendment No. 166, in page 1, line 10, leave out clause 2.
	Amendment No. 96, in clause 2, page 1, line 12, after 'Foundation', insert 'and Community'.
	Amendment No. 168, in page 2, line 3, leave out clause 3.
	Amendment No. 169, in page 2, line 9, leave out clause 4.
	Amendment No. 154, in clause 4, page 2, line 10, after 'trust', insert
	'or combination of NHS trusts'.
	Amendment No. 321, in page 2, line 10, after 'trust', insert
	'or a Primary Care Trust'.
	Amendment No. 65, in page 2, leave out line 12 and insert 'appropriate Minister'.
	Amendment No. 322, in clause 4, page 2, line 12, at end insert—
	'(1A) The Secretary of State may not support more than six applications make by NHS trusts and more than six applications made by Primary Care Trusts during the pilot test period.'.
	Amendment No. 155, in page 2, line 14, after 'trust', insert 'or trusts'.
	Amendment No. 323, in page 2, line 14, after 'trust', insert 'or Primary Care Trust'.
	Amendment No. 156, in page 2, line 18, after 'trust', insert 'or trusts'.
	Amendment No. 324, in page 2, line 18, after 'trust', insert 'or Primary Care Trust'.
	Amendment No. 157, in page 2, line 19, after 'applicant', insert 'or applicants'.
	Amendment No. 158, in page 2, line 21, after 'has', insert 'or NHS trusts have'.
	Amendment No. 325, in page 2, line 21, after 'trust', insert
	'or a Primary Care Trust'.
	Amendment No. 159, in page 2, line 26, after 'trust', insert 'or trusts'.
	Amendment No. 326, in page 2, line 26, after 'trust', insert 'or Primary Care Trust'.
	Amendment No. 160, in page 2, line 28, at end insert 'or them'.
	Amendment No. 161, in page 2, line 29, after 'it', insert 'or them'.
	Amendment No. 170, in page 2, line 31, leave out clause 5.
	Amendment No. 328, in clause 5, page 2, line 32, after 'trust', insert
	'or a Primary Care Trust'.
	Amendment No. 66, in page 2, leave out line 35 and insert 'appropriate Minister'.
	Government amendment No. 245.
	Amendment No. 171, in page 3, line 20, leave out clause 6.
	Amendment No. 329, in clause 6, page 3, line 22, after 'trust', insert
	'or a Primary Care Trust'.
	Amendment No. 233, in page 3, line 27, at end insert—
	'( ) taken as a whole the actual membership of the applicant's public constituency will be representative of those eligible for such membership,'.
	Amendment No. 402, in page 3, line 37, leave out subsection (4) and insert—
	'(4) In deciding whether or not to give an authorisation in response to an application under section 4 or 5, the regulator shall have regard to the outcome of a public consultation under section [public consultation relating to applications for foundation status].'.
	Amendment No. 403, in page 3, line 39, at end insert—
	'(4A) The regulator shall not give an authorisation under section 7(1)(a) or (b) unless and until the Secretary of State confirms support for the application to which such authorisation may relate after responding to—
	(a) any recommendations made to him by virtue of section 21(2)(f) of the Local Government Act 2000 (Overview and Scrutiny Committees) in relation to the application, or
	(b) any referrals or representations made to him by any Patients Forum by virtue of section 15(6) of the NHS Reform and Healthcare Professions Act 2002 in relation to the application.'.
	Amendment No. 172, in page 4, line 1, leave out clause 7.
	Amendment No. 330, in clause 7, page 4, line 2, after 'trust', insert
	'or a Primary Care Trust'.
	Amendment No. 331, in page 4, line 3 after 'trust', insert
	'or a Primary Care Trust as the case may be'.
	Amendment No. 100, in page 4, line 4, at end insert—
	'(1A) On an authorisation being given to a Primary Care Trust—
	(a) it ceases to be a Primary Care Trust and becomes an NHS community trust,
	(b) the proposed constitution has effect.'.
	Amendment No. 101, in page 4, line 10, at end insert
	'or community trust as the case may be'.
	Amendment No. 102, in page 4, line 13, after 'trust, insert 'or community trust'.
	Amendment No. 173, in page 4, line 17, leave out clause 8.
	Amendment No. 103, in clause 8, page 4, line 18, after 'trust', insert 'or community trust'.
	Amendment No. 104, in page 4, line 20, after 'trust, insert 'or community trust'.
	Amendment No. 174, in page 4, line 22, leave out clause 9.
	Amendment No. 175, in page 4, line 35, leave out clause 10.
	Amendment No. 105, in clause 10, page 4, line 37, at end insert 'and community trusts'.
	Amendment No. 106, in page 4, line 38, at end insert 'and community trust'.
	Amendment No. 107, in page 5, line 6, after 'trust', insert 'or community trust'.
	Government amendment No. 355.
	Amendment No. 67, in page 5, line 14, leave out 'Secretary of State' and insert 'appropriate Minister'.
	Amendment No. 176, in page 5, line 17, leave out Clause 11.
	Amendment No. 68, in clause 11, page 5, line 18, leave out 'Secretary of State' and insert 'appropriate Minister'.
	Amendment No. 108, in page 5, line 19, after 'trust', insert 'or community trust'.
	Government amendment No. 356.
	Amendment No. 177, in page 5, line 22, leave out clause 12.
	Amendment No. 109, in clause 12, page 5, line 24, at end insert 'or community trust'.
	Government amendment No. 246.
	Amendment No. 69, in page 5, line 29, at end insert—
	'(aa) the Assembly,'.
	Amendment No. 332, in page 5, line 30, after 'trust', insert 'and Primary Care Trust'.
	Amendment No. 110, in page 5, line 31, at end insert—
	'(bb) every Primary Care Trust intending to make an application to become an NHS community trust,'.
	Amendment No. 70, in page 5, line 33, at end insert
	'and send a copy to the Assembly'.
	Amendment No. 111, in page 5, line 36, at end insert 'and community trust'.
	Amendment No. 178, in page 5, line 37, leave out clause 13.
	Amendment No. 333, in clause 13, page 5, line 38, after first 'trust', insert
	'or a Primary Care Trust'.
	Amendment No. 112, in page 5, line 38, after second 'trust', insert
	'or a Primary Care Trust becomes an NHS community trust'.
	Amendment No. 113, in page 5, line 40, at end insert 'or community trust'.
	Amendment No. 114, in page 6, line 3, after 'trust', insert 'or community trust'.
	Amendment No. 71, in page 6, line 6, leave out 'Secretary of State' and insert 'appropriate Minister'.
	Amendment No. 72, in page 6, line 10, after 'England', insert
	'or (as the case may be) in Wales'.
	Amendment No. 73, in page 6, line 12, leave out 'Secretary of State' and insert 'appropriate Minister'.
	Amendment No. 74, in page 6, line 14, leave out 'Secretary of State' and insert 'appropriate Minister'.
	Amendment No. 115, in page 6, line 14, after 'trust', insert 'or community trust'.
	Amendment No. 179, in page 6, line 18, leave out clause 14.
	Amendment No. 75, in clause 14, page 6, line 23, at end insert 'and Wales'.
	Amendment No. 76, in page 6, line 28, after 'England', insert 'and Wales'.
	Amendment No. 77, in page 6, line 37, after 'England', insert 'and Wales'.
	Amendment No. 180, in page 7, line 13, leave out clause 15.
	Amendment No. 397, in clause 15, page 7, line 14, leave out 'may' and insert 'must'.
	Amendment No. 78, in page 7, line 15, after 'England', insert 'and Wales'.
	Government amendment No. 247.
	Amendment No. 398, in page 7, line 17, leave out 'power' and insert 'duty'.
	Government amendment No. 248.
	Amendment No. 400, in page 7, line 23, at end insert—
	'(3A) An authorisation must state that no services be provided to a patient, other than an NHS patient, by an NHS foundation trust, other than in circumstances prescribed by subsection (3B).
	(3B) These circumstances are that a certificate issued by the lead clinician in that specialty states that the services so provided are not needed by an NHS patient with equal or greater clinical need.'.
	Amendment No. 181, in page 7, line 28, leave out clause 16.
	Amendment No. 116, in clause 16, page 7, line 29, after 'trust', insert 'or community trust'.
	Amendment No. 79, in page 7, line 38, at end insert 'and Wales'.
	Amendment No. 117, in page 7, line 41, after 'trust', insert 'or community trust'.
	Amendment No. 182, in page 8, line 1, leave out clause 17.
	Amendment No. 118, in clause 17, page 8, line 2, after 'trust', insert 'or community trust'.
	Amendment No. 119, in page 8, line 7, after 'trust', insert 'or community trust'.
	Amendment No. 120, in page 8, line 12, after 'trust', insert 'or community trust'.
	Amendment No. 183, in page 8, line 15, leave out clause 18.
	Amendment No. 121, in clause 18, page 8, line 16, after 'trust', insert 'or community trust'.
	Amendment No. 122, in page 8, line 22, after 'trust', insert 'or community trust'.
	Amendment No. 184, in page 8, line 29, leave out clause 19.
	Amendment No. 123, in clause 19, page 8, line 31, after 'trust', insert 'or community trust'.
	Amendment No. 80, in page 8, line 32, leave out 'Secretary of State' and insert 'appropriate Minister'.
	Amendment No. 124, in page 8, line 33, after 'trust', insert 'or community trust'.
	Amendment No. 185, in page 8, line 37, leave out clause 20.
	Amendment No. 125, in clause 20, page 8, line 38, after 'trust', insert 'or community trust'.
	Amendment No. 186, in page 9, line 1, leave out clause 21.
	Amendment No. 126, in clause 21, page 9, line 2, after 'trust', insert 'or community trust'.
	Amendment No. 187, in page 9, line 4, leave out clause 22.
	Amendment No. 81, in clause 22, page 9, line 5, leave out 'Secretary of State' and insert 'appropriate Minister'.
	Amendment No. 127, in page 9, line 6, after first 'trust', insert 'or community trust'.
	Amendment No. 128, in page 9, line 7, after 'trust', insert 'or community trust'.
	Amendment No. 82, in page 9, line 13, leave out 'Secretary of State' and insert 'appropriate Minister'.
	Amendment No. 83, in page 9, line 17, leave out 'Secretary of State' and insert 'appropriate Minister'.
	Amendment No. 129, in page 9, line 21, after 'trust', insert 'or community trust'.
	Amendment No. 84, in page 9, line 22, leave out 'Secretary of State' and insert 'appropriate Minister'.
	Amendment No. 130, in page 9, line 23, after 'trust', insert 'or community trust'.
	Amendment No. 188, in page 9, line 28, leave out clause 23.
	Amendment No. 131, in clause 23, page 9, line 30, after 'trust', insert 'or community trust'.
	Amendment No. 132, in page 9, line 34, after 'trust', insert 'or community trust'.
	Amendment No. 189, in page 10, line 7, leave out clause 24.
	Amendment No. 133, in clause 24, page 10, line 9, after 'trust', insert 'or community trust'.
	Amendment No. 134, in page 10, line 14, after 'trusts', insert 'or community trusts'.
	Amendment No. 190, in page 10, line 17, leave out clause 25.
	Amendment No. 135, in clause 25, page 10, line 19, after 'trust', insert 'or community trust'.
	Amendment No. 136, in page 10, line 32, at end insert 'or community trust'.
	Amendment No. 85, in page 10, line 33, at end insert—
	'(bb) a Local Health Board,'.
	Amendment No. 86, in page 10, line 35, leave out 'Secretary of State' and insert 'appropriate Minister'.
	Amendment No. 137, in page 10, line 42, at end insert 'or organisation'.
	Amendment No. 138, in page 11, line 1, after 'trust', insert 'or community trust'.
	Amendment No. 139, in page 11, line 2, at end insert 'or organisation'.
	Amendment No. 192, in page 11, line 3, leave out clause 26.
	Amendment No. 87, in clause 26, page 11, line 5, leave out 'Secretary of State' and insert 'appropriate Minister'.
	Amendment No. 193, in page 11, line 18, leave out clause 27.
	Amendment No. 140, in clause 27, page 11, line 20, leave out 'and NHS foundation trusts' and insert
	', NHS foundation trusts and NHS community trusts'.
	Amendment No. 194, in page 11, line 23, leave out clause 28.
	Amendment No. 141, in clause 28, page 11, line 26, at end insert—
	'(e) NHS community trusts'.
	Amendment No. 195, in page 11, line 27, leave out clause 29.
	Amendment No. 142, in clause 29, page 11, line 36, at end insert—
	'(fb) NHS community trusts;'.
	Amendment No. 143, in page 12, line 3, after 'trust', insert 'or community trust'.
	Amendment No. 196, in page 12, line 5, leave out clause 30.
	Amendment No. 145, in clause 30, page 12, line 9, leave out 'and NHS foundation trusts' and insert
	', NHS foundation trusts and NHS community trusts'.
	Amendment No. 197, in page 12, line 11, leave out clause 31.
	Amendment No. 146, in clause 31, page 12, line 15, at end insert—
	'(bc) an NHS community trust;'.
	Amendment No. 198, in page 12, line 21, leave out clause 32.
	Amendment No. 200, in page 12, line 24, leave out clause 33.
	Amendment No. 147, in clause 33, page 12, line 26, after 'trust', insert 'or community trust'.
	Government amendments Nos. 249 to 251.
	Amendment No. 201, in page 13, line 3, leave out clause 34.
	Amendment No. 148, in clause 34, page 13, line 4, after 'trust', insert 'or community trust'.
	Amendment No. 202, in page 13, line 7, leave out clause 35.
	Amendment No. 91, in clause 35, page 13, line 10, at end insert—
	'"the appropriate Minister" means—
	(a) in relation to England, the Secretary of State; and
	(b) in relation to Wales, the Assembly,
	"the Assembly" means the National Assembly for Wales,'.
	Government amendment No. 357.
	Amendment No. 92, in page 13, line 13, leave out
	'or a Primary Care Trust'
	and insert
	', a Primary Care Trust or a Local Health Board'.
	Amendment No. 320, in page 13, line 14, at end insert—
	'"parliamentary constituency" has the meaning given in section 1 of the Parliamentary Constituencies Act 1986 (c.56) (parliamentary constituencies);
	"the pilot test period" means the period that—
	(a) begins with the day on which the first order is made under section 184 which brings into force a provision of this Part, and
	(b) ends three years after the day referred to in paragraph (a);'.
	Government new clause 25—Audit.
	Government new clause 36—Mergers.
	Government new clause 37—Section (Mergers): supplementary.
	New clause 1—Review of democratically accountable governance—
	'(1) It shall be the duty of the Secretary of State to establish an independent review body to carry out the functions specified in subsections (4) to (6).
	(2) The Secretary of State shall appoint at least nine members to the independent review body.
	(3) The independent review body shall elect a Chairman from amongst its members.
	(4) The independent review body shall prepare reports containing proposals relating to the establishment of a local, democratically accountable system of governance for NHS foundation trusts and Primary Care Trusts.
	(5) The independent review body may in particular make proposals in accordance with the provisions of subsection (4) relating to—
	(a) methods of securing wider public participation in the governance of NHS foundation trusts and Primary Care Trusts;
	(b) methods of increasing public awareness and access to information about the governance of NHS foundation trusts and Primary Care Trusts; and
	(c) the membership of public benefit corporations.
	(6) The independent review body must—
	(a) lay a copy of any report prepared in accordance with the provisions of this section before Parliament, and
	(b) once they have done so, send a copy of it to—
	(i) the Secretary of State, and
	(ii) the regulator.'.
	New clause 9—Foundation patients' fora—
	'(1) The Secretary of State shall establish a body to be known as a Foundation Patients' Forum—
	(a) for each NHS Trust which has made an application under section 4(2);
	(b) for each person who has been incorporated as a public benefit corporation under section 5(5).
	(2) The members of the Foundation Patients' Forum are to be appointed by the Commission for Patient and Public Involvement in Health.
	(3) Once the Foundation Patients' Forum has been established, it may do anything (including the things mentioned in subsection (4) below) which appears to it to be necessary or desirable for the purpose of preparing for effective patient and public involvement in the NHS Trust or public benefit corporation once it becomes a Foundation Trust.
	(4) A Foundation Patients' Forum must—
	(a) monitor and review the range and operation of services provided by, or under arrangements made by, the trust for which it is established,
	(b) obtain the views of patients' and their carers about those matters and report on those views to the trust,
	(c) provide advice, and make reports and recommendations, about matters relating to the range and operation of those services to the trust,
	(d) make available to patients and their carers advice and information about those services,
	(e) in prescribed circumstances, perform any prescribed function of the trust with respect to the provision of a service affording assistance to patients and their families and carers,
	(f) carry out such other functions as may be prescribed.
	(5) In providing advice or making recommendations under subsection (4)(c), a Foundation Patients' Forum must have regard to the views of patients and their carers.
	(6) If, in the course of exercising its functions, a Foundation Patients' Forum becomes aware of any matter which in its view—
	(a) should be considered by a relevant overview and scrutiny committee, the Forum may refer that matter to the committee,
	(b) should be brought to the attention of the Commission for Patient and Public Involvement in Health, it may refer that matter to the Commission.
	(7) Subsection (6) does not prejudice the power of a Foundation Patients' Forum to make such other representations or referrals as it thinks fit, to such persons or bodies as it thinks fit about matters arising in the course of its exercising its functions.
	(8) An NHS Trust or public benefit corporation exercising its powers under sections 4(4)(b) or 5(7)(b) as the case may be shall be obliged to have regard to and take account of the reports and recommendations of the Foundation Patients' Forum.
	(9) The governors and non-executive directors of the Foundation Trust shall be obliged to respond in writing to the reports and recommendations of the Foundation Patients' Forum.
	(10) All the members, governors and directors of a Foundation Trust shall be obliged to have regard to and take account of the reports and recommendations of the Foundation Patients' Forum in exercising their functions within the Foundation Trust.
	(11) The terms in this section shall be construed in accordance with the provisions of section 15(8) and (9) of the National Health Service Reform and Health Care Professions Act 2002 (c.17).'.
	New clause 18—Community Health Councils and NHS foundation trusts in Wales—
	'(1) Schedule 7A of the 1977 Act is amended as follows.
	(2) In paragraph 2 (general provisions)—
	(a) in subparagraph (f), for "and NHS trusts" there is substituted ", NHS trusts and NHS foundation trusts";
	(b) in subparagraph (g), for "and NHS trusts" there is substituted ", NHS trusts and NHS foundation trusts";
	(c) in subparagraph (j), for "and NHS trusts" there is substituted ", NHS trusts and NHS foundation trusts";
	(d) in subparagraph (k), for "or NHS trusts" there is substituted ", NHS trusts or NHS foundation trusts".
	(3) In paragraph 3 (entry and inspection of premises), in subparagraph (1), after sub-subparagraph (f) there is inserted—
	"(fa) NHS foundation trusts;".
	New clause 19—NHS community trusts—
	'(1) An NHS community trust is a public benefit organisation which is authorised to commission goods and services for the purposes of the health service in England.
	(2) A public benefit organisation is a body corporate which, in pursuance of an application, is constituted in accordance with Schedule [constitution of public benefit organisations].'.
	New clause 20—Applications by Primary Care Trusts—
	'(1) A Primary Care Trust may make an application to the regulator for authorisation to become an NHS community trust if the application is supported by the Secretary of State.
	(2) The application must—
	(a) describe the goods and services which the applicants propose should be commissioned by the NHS community trust,
	(b) describe the goods and services which the applicants propose should be provided by the NHS community trust, and
	(c) be accompanied by a copy of the proposed constitution of the trust;
	and must give any further information which the regulator requires the Primary Care Trust to give.
	(3) The applicant may modify the application with the agreement of the regulator at any time before authorisation is given under section [authorisation of NHS community trusts].
	(4) Once a Primary Care Trust has made the application—
	(a) the provisions of the proposed constitution which give effect to paragraphs 3 to 16 of Schedule [constitution of public benefit organisations] have effect, but only for the purpose of electing a shadow board of governors and appointing a shadow board of directors,
	(b) the Primary Care Trust may do anything (including the things mentioned in paragraph 16 of Schedule 2 to the National Health Service and Community Care Act 1990 (c.19) (general powers)) which appears to it to be necessary or desirable for the purpose of preparing it for NHS community trust status.'.
	New clause 21—Authorisation of NHS community trusts—
	'(1) The regulator may give an authorisation under this section to a Primary Care Trust which has applied under section [applications by Primary Care Trusts] if he is satisfied as to the matters specified in subsection (2).
	(2) The matters are that—
	(a) the applicant's constitution will be in accordance with Schedule [constitution of public benefit organisations] and will otherwise be appropriate,
	(b) there will be a board of governors, and a board of directors, constituted in accordance with the constitution,
	(c) the steps necessary to prepare for NHS community trust status have been taken,
	(d) the applicant will be able to commission or the goods and services or to provide the goods and services which the authorisation is to require it to commission or to provide, and
	(e) any other requirements which he considers appropriate are met.
	(3) Subject to the provisions of subsection (4), the authorisation may be given on any terms the regulator considers appropriate.
	(4) An authorisation must authorise the NHS community trust to commission goods and services for the purposes of the health service in England.
	(5) If regulations require the applicant to consult prescribed persons about the application, the regulator may not give an authorisation unless he is satisfied that the applicant has complied with the regulations.'.
	New clause 24—Representative membership—
	'An authorisation may require an NHS foundation trust to take steps to secure that (taken as a whole) the actual membership of its public constituency is representative of those eligible for such membership.'.
	New clause 34—Extension of provisions of Part 1 following pilot tests—
	'(1) Within three months of the conclusion of the pilot test period—
	(a) the Secretary of State,
	(b) the regulator,
	(c) the CHAI, and
	(d) the Comptroller and Auditor General
	shall lay before each House of Parliament a report on the operation of the provisions of Part 1 of this Act during the pilot test period.
	(2) After all of the reports under subsection (1) have been laid before Parliament, the Secretary of State may by order—
	(a) amend the provisions of Part 1 so as to extend the application to other NHS trusts and Primary Care Trusts, and
	(b) make such other amendments of Part 1 as arise from the reports.
	(3) No order may be made under subsection (2) unless a draft of the order has been laid before and approved by a resolution of each House of Parliament.'.
	New clause 39—Public consultation relating to applications for foundation status—
	'(1) The Secretary of State shall—
	(a) by regulations require that an NHS Trust proposing to make an application under section 4(1) or any person proposing to apply under section 5(1) shall first consult prescribed persons, and
	(b) by regulations prescribe persons to be consulted which shall include the Patients Forums for the NHS Trusts and Primary Care Trusts in the area in which are resident all or any of the persons to whom the applicant NHS Trust has provided goods or services for the purposes of healthcare or to whom the applicant or person (as the case may be) intends to provide such services if its application is successful.
	(2) In section 7(3) of the Health and Social Care Act 2001 (functions of Overview and Scrutiny Committees)—
	(a) at the beginning of subsection (3) (matters to be covered by regulations) for "may" there is substituted "shall";
	(b) at the end of subsection (3)(b) there is inserted "which shall include all matters prescribed under subsection 7(3)(c) below,";
	(c) at the end of subsection (3)(c) there is inserted "which shall include any application or proposed application under section 4 of the Health and Social Care (Community Health and Standards) Act 2003".'.
	Government new schedule 2—Audit of accounts of NHS foundation trusts.
	New schedule 1—Constitution of public benefit organisations—
	Requirement for a constitution
	1 (1) A public benefit organisation is to have a constitution.
	(2) As well as any provision authorised or required to be made by this Schedule, the constitution may make further provision (other than provision as to the powers of the organisation) consistent with this Schedule.
	2 The constitution is to name the organisation and, if the organisation is an NHS community trust, its name must include the words "NHS community trust".
	Members
	3 (1) The members of a public benefit organisation are to be individuals who—
	(a) live in the area specified for the purpose in the constitution ("the public constituency"), or
	(b) are employed by the organisation ("the staff constituency").
	(2) The constitution may also provide for the public constituency to comprise individuals who have received goods or services commissioned or provided by the Primary Care Trust as patients (including individuals attending as the carer of a patient).
	(3) The constitution may also provide for the staff constituency to comprise NHS professionals who provide services to the Primary Care Trust or who a self-employed contractor or in a self-employed contract with the Primary Care Trust.
	(4) Subparagraph (1)(a) does not apply to a person who is eligible for membership of the staff constituency.
	4 The constitution is to require a minimum number of members of each constituency.
	5 (1) A person may not be a member of a public benefit organisation unless he has agreed to pay a sum not exceeding £1 to the organisation.
	(2) A person may not be a member of a public benefit organisation if—
	(a) he has been adjudged bankrupt or has made a composition or arrangement with his creditors,
	(b) he has within the preceding five years been convicted in the British Islands of any offence if a sentence of imprisonment (whether suspended or not) for a period of three months or more (without the option of a fine) was imposed on him.
	(3) The constitution may make further provision as to the circumstances in which a person may not be a member.
	Board of Governors
	6 (1) A public benefit organisation is to have a board of governors.
	(2) Only the following may be members of the board—
	(a) members of the organisation, and
	(b) individuals appointed under the following provisions who do not fall within paragraph 5(2)(a) or (b).
	(3) The members of the board other than the appointed members are to be chosen by election.
	(4) Members of the public constituency or the staff constituency may elect any of their number to be a member of the board.
	(5) If contested, the election must be by postal ballot.
	7 (1) More than half of the members of the board of governors are to be elected by the public constituency.
	(2) Not fewer than one third of the members of the board are to be elected by the staff constituency.
	8 (1) A member of the board of governors elected by the public constituency or the staff constituency may hold office for a period of three years.
	(2) Such a member is to be eligible for re-election at the end of that period.
	(3) But a person elected to membership of the board ceases to hold office if he ceases to be a member of the relevant constituency.
	9 The organisation may pay travelling and other expenses to members of the board of governors at rates decided by the organisation.
	10 The constitution is to provide for the chairman of the organisation or (in his absence) another person to preside at meetings of the board of governors.
	11 (1) The constitution is to provide for meetings of the board of governors to be open to members of the public.
	(2) But the constitution may provide for members of the public to be excluded from a meeting for special reasons.
	12 (1) The constitution is to make provision as to—
	(a) the conduct of elections for membership of the board,
	(b) the appointment of persons to membership,
	(c) the practice and procedure of the board,
	(d) the removal of a member from office.
	(2) The constitution may make further provision about the board.
	Directors
	13 (1) A public benefit organisation is to have a board of directors.
	(2) The constitution is to provide for all the powers of the organisation to be exercisable by the board of directors on its behalf.
	(3) But the constitution may provide for any of those powers to be delegated to a committee of directors or to an executive director.
	14 (1) The board is to consist of—
	(a) executive directors, one of whom is to be the chief executive and another the finance director,
	(b) non-executive directors, one of whom is to be the chairman.
	(2) Only a member of the public constituency is eligible for appointment as a non-executive director.
	15 (1) It is for the board of governors at a general meeting to appoint or remove the non-executive directors.
	Removal of a non-executive director under this subparagraph requires the approval of three-quarters of the members of the board.
	(2) It is for the non-executive directors to appoint or remove the chief executive.
	(3) It is for the chief executive to appoint or remove the executive directors.
	(4) An appointment or removal under subparagraph (2) or (3) requires the approval of a majority of the board of governors voting at a general meeting.
	16 (1) It is for the board of governors at a general meeting to decide the remuneration and allowances, and the other terms and conditions of office, of the non-executive directors.
	(2) The organisation is to establish a committee of non-executive directors to decide the remuneration and allowances, and the other terms and conditions of office, of the executive directors.
	Register of members etc.
	17 (1) A public benefit organisation is to have—
	(a) a register of members showing, in respect of each member, the constituency to which he belongs,
	(b) a register of members of the board of governors,
	(c) a register of directors.
	(2) The constitution may make further provision about the registers including, in particular, admission to, and removal from, the registers.
	18 (1) The following documents of a public benefit organisation are to be available for inspection by members of the public free of charge at all reasonable times—
	(a) a copy of the current constitution,
	(b) a copy of the current authorisation,
	(c) the register of members, the register of members of the board of governors and the register of directors,
	(d) a copy of the latest annual accounts and of any report of the auditor on them,
	(e) a copy of the latest annual report,
	(f) a copy of the latest information as to its forward planning.
	(2) Any person who requests it is to be provided with a copy of or extract from any of the above documents.
	(3) If the person requesting the copy or extract is not a member of the organisation, the organisation may impose a reasonable charge for doing so.
	Auditor
	19 (1) A public benefit organisation is to have an auditor.
	(2) It is for the board of governors to appoint or remove the auditor at a general meeting of the board.
	(3) But a person may not be appointed as auditor unless he (or, in the case of a firm, each of its members) is a member of one or more of the following bodies—
	(a) the bodies mentioned in section 3(7)(a) to (e) of the Audit Commission Act 1998 (c.18),
	(b) any other body of accountants established in the United Kingdom and for the time being approved by the Secretary of State for the purposes of this paragraph.
	(4) The organisation is to establish a committee of non-executive directors to monitor the exercise of the auditor's functions.
	Accounts
	20 (1) A public benefit organisation is to keep accounts in such form as the Secretary of State may with the approval of the Treasury direct.
	(2) The accounts are to be audited by the organisation's auditor.
	(3) But the Comptroller and Auditor General may examine—
	(a) the accounts,
	(b) any records relating to them, and
	(c) any report of the auditor on them.
	21 (1) A public benefit organisation is to prepare in respect of each financial year annual accounts in such form as the Secretary of State may with the approval of the Treasury direct.
	(2) In preparing its annual accounts, the organisation is to comply with any directions given by the Secretary of State with the approval of the Treasury as to—
	(a) the methods and principles according to which the accounts are to be prepared,
	(b) the information to be given in the accounts.
	(3) In determining the form and content of the annual accounts the Secretary of State is to aim to ensure that the accounts present a true and fair view.
	(4) The organisation must—
	(a) lay a copy of the annual accounts, and any report of the auditor on them, before Parliament, and
	(b) once it has done so, send copies of those documents to the Secretary of State.
	(5) In this paragraph and paragraph 23 "financial year" means—
	(a) the period beginning with the date on which the organisation is authorised under section [authorisation of NHS community trusts] and ending with the next 31st March, and
	(b) each successive period of twelve months beginning with 1st April.
	Annual reports and forward plans
	22 (1) A public benefit organisation is to prepare annual reports and send them to the Secretary of State.
	(2) The reports are to give any information the Secretary of State requires.
	(3) It is for the Secretary of State to decide—
	(a) the form of the reports,
	(b) when the reports are to be sent to him,
	(c) the periods to which the reports are to relate.
	23 (1) A public benefit organisation is to give information as to its forward planning in respect of each financial year to the Secretary of State.
	(2) The information is to be prepared by the directors after consulting the board of governors.
	Meeting of board of governors to consider annual accounts and reports
	24 The following documents are to be presented to the board of governors of a public benefit organisation at a general meeting—
	(a) the annual accounts,
	(b) any report of the auditor on them,
	(c) the annual report.
	Instruments etc.
	25 (1) The constitution is to make provision for the authentication of the fixing of the organisation's seal.
	(2) A document purporting to be duly executed under the organisation's seal or to be signed on its behalf is to be received in evidence and, unless the contrary is proved, taken to be so executed or signed.'.
	Amendment No. 165, in page 99, line 2, leave out schedule 1.
	Government amendment No. 253.
	Amendment No. 228, in schedule 1, page 99, line 18, at end insert
	'other than those attending accident and emergency who have been treated and discharged within one hour of being medically examined'.
	Government amendment No. 254.
	Amendment No. 229, in page 99, line 25, at end insert—
	'(2) The minimum number of members required in the public constituency shall not be less than 15 per cent. of those registered to vote in local government elections in the area specified for the purpose in the constitution.'.
	Amendment No. 334, in page 99, line 26, leave out paragraph 5 and insert—
	'5(1) All persons who are entitled to vote in parliamentary elections in parliamentary constituencies which fall (partly or wholly) within the area specified for the purposes of paragraph 3(1) in respect of a public benefit corporation shall be members of that corporation.
	(2) For the purposes of this paragraph, entitlement to vote shall be determined in accordance with the provisions of section 1 of the Representation of the People Act 1983 (c.2) (parliamentary electors).'.
	Government amendments Nos. 255 to 257.
	Amendment No. 335, in page 100, line 2, at end insert
	'comprising twelve members, eight of whom are to be elected and four of whom are to be co-opted'.
	Amendment No. 404, in page 100, line 2, at end insert
	'members of which are to be appointed from the constituencies set out in paragraph 7'.
	Government amendment No. 258.
	Amendment No. 336, in page 100, line 5, leave out 'appointed' and insert 'co-opted'.
	Amendment No. 337, in page 100, line 5, leave out from 'provisions' to end of line 6.
	Amendment No. 405, in page 100, line 7, leave out subparagraph (3).
	Amendment No. 338, in page 100, line 7, leave out 'appointed' and insert 'co-opted'.
	Amendment No. 339, in page 100, line 8, at end insert—
	'(3A) Members of the public constituency may elect any of their number to be a member of the board.
	(3B) To be eligible to stand for election a member must—
	(a) have been nominated by at least 50 other members of the public constituency in accordance with the provisions of Schedule 1 of the Representation of the People Act 1983 (c.2), and
	(b) have his main residence within the area specified for the purposes of paragraph 3(1) in respect of the public benefit corporation.
	(3C) The provisions of Part 1 of the Representation of the People Act 1983 shall apply to elections under this paragraph in respect of the public constituency as they apply to parliamentary elections, subject to such modifications as the Secretary of State may by order specify.'.
	Amendment No. 406, in page 100, line 9, leave out subparagraph (4).
	Amendment No. 340, in page 100, line 9, leave out 'public constituency or the'.
	Amendment No. 407, in page 100, line 11, leave out subparagraph (5).
	Amendment No. 341, in page 100, line 11, after 'election', insert
	'in respect of the staff constituency'.
	Government amendment No. 259.
	Amendment No. 230, in page 100, line 11, at end insert—
	'(6) The board of governors shall not be properly constituted unless at least 20 per cent. of members of the relevant constituency have voted in the election.'.
	Government amendment No. 260.
	Amendment No. 408, in page 100, line 12, leave out subparagraph (1) and insert—
	'(1) The trust will propose a scheme for approval by the Secretary of State for the constitution of the board of governors, which must include the following constituencies—
	(a) elected members of the local authority;
	(b) groups representing the local community;
	(c) persons representing the staff of the trust;
	(d) persons representing local Primary Care Trusts;
	(e) a university, if the hospital includes a medical or dental school provided by the university; and
	(f) any other groups the Board identifies as appropriate.
	(1A) The balance of membership will be decided by individual boards.'.
	Amendment No. 342, in page 100, line 12, leave out 'More than half' and insert 'Seven'.
	Amendment No. 343, in page 100, line 14, leave out 'At least'.
	Amendment No. 344, in page 100, line 15, leave out 'appointed by' and insert 'co-opted to represent'.
	Amendment No. 61, in page 100, line 15, at end insert
	'(in England) or a Local Health Board (in Wales)'.
	Amendment No. 345, in page 100, line 15, at end insert
	'in the case of a public benefit corporation primarily providing hospital services and an NHS hospital in the case of a public benefit corporation primarily providing primary care services'.
	Amendment No. 354, in page 100, line 16, at end insert—
	'( ) At least one member of the board is to be appointed by one or more qualifying local authorities.
	A qualifying local authority is a local authority for an area which includes the whole or part of the area specified under paragraph 3(1)(a).'.
	Amendment No. 346, in page 100, line 18, leave out 'appointed by' and insert 'co-opted to represent'.
	Government amendment No. 261.
	Amendment No. 347, in page 100, line 19, at end insert—
	'(5) The co-opted members shall be so co-opted by a decision of the elected members of the board.
	(6) The chairman may (with the agreement of the majority of the board) remove any of the co-opted members.'.
	Amendment No. 348, in page 101, line 6, at end insert—
	'(1A) The chairman shall be one of the members of the board of governors elected in respect of the public constituency.'.
	Government amendments Nos. 262 and 263.
	Amendment No. 242, in page 101, line 28, at end insert—
	'(d) a register of interests of the directors.'.
	Amendment No. 243, in page 101, line 30, at end insert—
	'17A The constitution is to make provision for dealing with conflicts of interest of the directors.'.
	Amendment No. 244, in page 101, line 36, leave out paragraph (c) and insert—
	'(c) the registers mentioned in paragraph 17,'.
	Amendment No. 349, in page 102, line 5, leave out subparagraphs (2) and (3) and insert—
	'(2) The auditor is to be the Comptroller and Auditor General.'.
	Amendment No. 350, in page 102, line 20, leave out 'corporation's auditor' and insert 'Comptroller and Auditor General'.
	Amendment No. 351, in page 102, line 21, leave out subparagraphs (3) and (4).
	Amendment No. 352, in page 102, line 39, leave out from 'and' to 'before' in line 40 and insert
	'the report of the Comptroller and Auditor General thereon'.
	Amendment No. 353, in page 103, line 6, at end insert—
	'(1A) The report shall contain a breakdown of the costs incurred by the public benefit corporation running elections and managing the membership.'.
	Amendment No. 234, in page 103, line 7, leave out 'any' and insert—
	'(a) information on any steps taken by the corporation to secure that (taken as a whole) the actual membership of its public constituency is representative of those eligible for such membership,
	(b) any other'.
	Amendment No. 167, in page 103, line 28, leave out schedule 2.
	Amendment No. 62, in schedule 2, page 104, line 13, at end insert—
	'Consultation with the Assembly
	2A The Secretary of State must consult the Assembly before exercising any of his functions under paragraphs 1 and 2 at any time after the day on which the Assembly notifies the Secretary of State of the Assembly's intention to make an order under section 184 in relation to Part 1.'.
	Government amendments Nos. 264 and 265.
	Amendment No. 63, in page 105, line 3, leave out 'Secretary of State' and insert 'appropriate Minister'.
	Amendment No. 64, in page 105, line 4, leave out 'Secretary of State' and insert 'appropriate Minister'.
	Amendment No. 97, in page 105, line 24, at end insert 'and Community'.
	Amendment No. 98, in page 105, line 28, after 'Foundation', insert 'and Community'.
	Amendment No. 99, in page 105, line 32, after 'Foundation', insert 'and Community'.
	Amendment No. 191, in page 105, line 33, leave out schedule 3.
	Amendment No. 199, in page 106, line 22, leave out schedule 4.
	Amendment No. 88, in schedule 4, page 110, line 10, leave out 'Secretary of State' and insert 'appropriate Minister'.
	Amendment No. 89, in page 110, line 15, leave out 'Secretary of State' and insert 'appropriate Minister'.
	Government amendment No. 266.
	Amendment No. 90, in page 113, line 38, leave out 'Secretary of State' and insert 'appropriate Minister'.
	Government amendments Nos. 358 and 267.
	Amendment No. 203, in clause 48, page 18, line 9, leave out subsections (6) and (7).
	Government amendment No. 371.
	Amendment No. 204, in page 19, line 1, leave out clause 50.
	Amendment No. 205, in clause 54, page 20, line 10, leave out subsection (2).
	Amendment No. 206, in page 21, line 1, leave out subsection (2).
	Government amendment No. 378.
	Amendment No. 207, in clause 116, page 51, line 32, leave out subsection (2).
	Amendment No. 149, in clause 139, page 60, line 20, at end insert—
	'(aa) an NHS community trust;'.
	Amendment No. 208, in page 60, leave out line 24.
	Amendment No. 93, in page 60, line 24, at end insert
	'all or most of whose hospitals, establishments or facilities are situated in England'.
	Amendment No. 209, in page 60, leave out line 47.
	Amendment No. 94, in page 61, line 17, at end insert—
	'(bb) an NHS foundation trust all or most of whose hospitals, establishments or facilities are situated in Wales;'.
	Amendment No. 219, in schedule 10, page 135, line 30, leave out sub-subparagraph (a).
	Amendment No. 220, in page 135, line 35, leave out 'an NHS foundation trust'.
	Amendment No. 221, in page 143, line 29, leave out sub-subparagraph (a).
	Amendment No. 222, in page 143, line 35, leave out 'NHS foundation trust or'.
	Amendment No. 223, in page 144, line 2, leave out 'or NHS foundation trust'.
	Amendment No. 224, in page 144, leave out line 20.
	Amendment No. 210, in clause 141, page 62, line 36, leave out paragraph (b).
	Government amendment No. 252.
	Amendment No. 211, in clause 151, page 73, line 29, leave out subparagraph (ii).
	Amendment No. 212, in clause 153, page 75, line 34, leave out subparagraph (ii).
	Amendment No. 213, in clause 156, page 77, line 29, at end insert 'or'.
	Amendment No. 214, in page 77, line 31, leave out from 'Act' to end of line 32.
	Amendment No. 215, in clause 175, page 94, leave out line 6.
	Amendment No. 216, in page 95 leave out line 31.
	Amendment No. 217, in clause 184, page 96, line 13, leave out '1' and insert '2'.
	Amendment No. 218, in page 96, line 18, leave out paragraph (a).
	Amendment No. 95, in page 96, line 18, leave out from 'Part 1' to end of line 19 and insert—
	'(i) for sections 2, 29 and 30, the Secretary of State;
	(ii) for section [Community Health Councils and NHS foundation trusts in Wales], the Assembly; and
	(iii) for the other provisions of the Part, and section 182 and Schedule 13 so far as relating to those provisions—
	(a) in relation to England, the Secretary of State; and
	(b) in relation to Wales, the Assembly;'.
	Amendment No. 225, in schedule 13, page 151, leave out lines 3 to 26.

David Hinchliffe: The purpose of the amendments tabled by my hon. Friends and I is to delete the foundation trust proposals from the Bill. I certainly support most of the remainder the Bill. It could be carried forward without part 1, which is the controversial element that many Labour Members oppose.
	There are three key reasons why I am a member of the Labour party: my party has traditionally stood for redistribution of wealth and a fairer society; it has traditionally stood for comprehensive education and equal opportunities; and it introduced a national health service based on sound socialist principles. I emphasise the word "national" in national health service because the concept of the national health service is fundamental to the debate.
	There was no national system before 1948. It was hit and miss as to whether local provision existed. There was a geographical lottery and people sometimes suffered as a direct consequence of that. Such a diversity of provision seems to be the aim now and I am worried that it will hit at the heart of much of what my party has achieved by bringing about the national health service.
	The current Government have a proud record on health. I pay tribute to my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) and the Health Ministers who are in the Chamber. I also pay tribute to my right hon. Friend the Member for Darlington (Mr. Milburn), who is not in the Chamber, for his contribution to many of the Government's health achievements.
	There is record investment in the national health service and record staff recruitment and training. We have a record capital programme to address hospitals that have been falling down for years and that suffered from gross under-investment. Pinderfields hospital, which is in my constituency, is such a hospital, and I am proud that we will soon have a new hospital. I am proud of the quality measures that the Government have introduced for our health care system. I am especially proud that we ended the Conservative internal market because my area experienced the two-tier system that was at the heart of our concerns about that. People living in the same street had different access to key health services, as I have said on many occasions in the House. I am proud that we set about getting rid of competition in a service that is essentially based on collectivism and co-operation.

Angela Eagle: I am looking in astonishment at the Conservative Benches, which are completely devoid of any Back Benchers except for one high-quality Member. The Labour Benches are packed with people who will debate passionately the future of our health service. Is that not the most telling thing that we have seen today?

David Hinchliffe: In defence of the hon. Member for South Cambridgeshire (Mr. Lansley), who is sitting on the Conservative Benches, he probably knows more about the health service than the rest of his colleagues put together.
	For the first time in the history of the health service, we have a Government who are committed to the empowerment of primary care. That is probably the most crucial policy development that they have achieved. The history of the health service has been dominated by the concerns of the acute hospital sector and by hospital consultants. We have never before exploited the potential of primary care, but primary care trusts are starting to achieve that. I strongly commend the steps that the Government have taken.

Howard Stoate: Does my hon. Friend agree that the ballot of general practitioners in which 80 per cent. voted in favour of the new GP contract shows that primary care physicians are committed to leading the NHS toward the modernisation that we so richly deserve in this century?

David Hinchliffe: I was delighted by the result of the GP ballot. It is also worth placing on record that the Royal College of General Practitioners, which represents GPs, including my hon. Friend, has come out strongly against foundation hospitals. No doubt he will take note of that point.
	I shall outline the key concerns that many of us have. One lesson that I learned through my work on the Select Committee on Health is that the last thing that our health care system needs is further restructuring and change, especially ill-considered change that has not had its potential consequences worked through. As I said on Second Reading, there have been 18 significant restructurings of our health care system during the past 20 years. People ask me where all the money has gone—it has gone on many of those restructurings.
	I have examined redundancy costs of staff who have gone down the road and early retirement costs. It is worth considering the possible salaries of the people who will be chief executives of the new foundation trusts. Some are campaigning enthusiastically for foundation status in the full knowledge that they are guaranteed to receive a huge salary hike. When we consider the use of scarce resources, we should be aware of how resources that should be used for patient care are being used—they are being used for ill-thought-out restructurings. I bet that there will be at least three more restructurings before the end of the proposed five-year roll-out of foundation hospitals. We should listen carefully to the many in the health service who say, "Enough is enough." We should let reforms bed down and let investment take effect so that we deliver on patient care.
	I mentioned my pride that the Labour Government have moved away from the internal market that the Tories introduced. One of my central worries about the principles that underpin foundation status is that the policy will mark a return to a market-oriented approach to health care. It will undoubtedly restore a competitive ethos, putting hospital against hospital and doctor against doctor. I know from talking to managers that they are looking over their shoulders at their rivals in their localities and elsewhere in the regions in which they are based.
	The policy is about winners and losers. It is clear from the Government's response to the Health Committee report on foundation trusts that capital spend by foundations will have an impact on the wider NHS. So when I talk to colleagues about their position on the issue and they say to me, "David, I'm going to have a foundation hospital in my constituency", I say, "That's all well and good, but have you thought about the impact on your neighbours?" There will be a foundation hospital near my constituency and I am aware of the serious impact that it will have on the health economy elsewhere in the west Yorkshire area. We have to consider that issue because it is fundamental to concerns about foundation status.

Louise Ellman: Does my hon. Friend share my concerns that the new system could lead to fragmentation and competing trading organisations—some in the public sector, some in the private sector—without us fully debating the implications of that concept in the Chamber?

David Hinchliffe: I do. In a sense, my hon. Friend takes me to my next point. A number of organisations that have lobbied against foundation status have said that it is a step towards privatisation. I have never said that. I did not make that claim on Second Reading and I do not think any of my hon. Friends who oppose foundation status made it either. However, a briefing document states:
	"a series of amendments were put down"
	in Committee
	"that open the doors to foundation hospitals actually being able to increase the amount of private work they undertake. Clause 15 of the Bill used to say that the regulator 'must' restrict the private work of the foundation hospitals; it now only says that the regulator 'may' restrict this work."
	Before my hon. Friend the Member for Lewisham, West (Jim Dowd), who will probably be in the Chamber later, accuses me of reading from a Unison briefing, the document was issued by the Independent Healthcare Association. It is a briefing from the private sector. The association fears that foundation hospitals will lead to more privatisation—more private work in those hospitals—and the impact that that will have on private hospitals. We have to take serious note of that. I have not raised the issue before, but I think that it is relevant in view of the association's comments.

Kevin Hughes: Does my hon. Friend recall campaigning against trust status, in particular the self-appointed quangos introduced by the Tories? We pledged that, when we got into government, we would do away with those. The Bill does that and installs local democracy. Does he not think that that will act as a check on the problem that he raises? I think that it will.

David Hinchliffe: If my hon. Friend looks at the Health Committee report, he will see that we calculated that, rather than getting rid of bureaucracy, the new system would increase it. I remember speaking in support of my hon. Friend's candidature when he stood in Doncaster and I argued against the Tory internal market. He was with me on that. He may not be with me at the moment, but the principles are the same. I hope that he understands that we are talking about the internal market, which he opposed before he became a Labour MP.

Kevin Hughes: Will my hon. Friend give way again?

David Hinchliffe: No. I want to make progress. My hon. Friend will have an opportunity to respond. I am conscious that other colleagues want to participate and I have some points to make before I conclude.
	A key consideration, which relates to my pride in the way in which the Government moved towards a primary care NHS, is that the policy on foundation hospitals runs directly contrary to that. It is a return to the dominance of certain acute hospitals. It does not make sense to talk about the new GP contract enhancing the role of primary care if we are suddenly to return to the empowerment of a small number of acute hospitals. That will be to the detriment of primary care and community care.
	I have argued many times in the Chamber for local governance of health. I have made all sorts of arguments over the years, including when I was on the Front Bench, about how we would achieve local governance, but it has been resisted up to now by the Labour party and its Front-Bench spokesmen. I welcome the commitment to move towards local governance, but I do not think that it has been properly thought through. We should consult on and think about some of the issues that it raises.
	I was interested to read the Health Service Journal this week, which reported the discussions at the NHS Confederation conference last week. It publishes the comments of two chairs of trusts that hope to receive foundation trust status. John Charlton, the chair of University hospital Birmingham, said:
	"We are only a matter of months away from foundation trusts and it doesn't seem to me that anybody has thought the governance through."
	He went on to say:
	"Yes, let's have autonomy, let's have accountability, but for goodness sake don't expect us to have a 5,000-strong membership. That would be an absolute nightmare."
	Frankly, if that is what a chair of an applicant trust is saying, I wonder where we are coming from because I would have thought that 5,000 would be a minimum.

Gordon Prentice: Will my hon. Friend give way?

David Hinchliffe: I want to carry on.
	Peter Dixon, the chair of University college London, another foundation trust applicant, remained concerned that those with an interest in governance might not represent the wider needs of the public. He said:
	"We will be choosing between the Hampstead Heath Conservation Society and the local Trotskyists. The Marsden"—
	the Royal Marsden in London—
	"is worried about animal-rights protesters because of their research . . . There is a danger of disenfranchising those who don't have sharp elbows."
	That sums up my concerns.

Several hon. Members: rose—

David Hinchliffe: With the greatest of respect, I want to conclude. I have given way several times and many hon. Members want to speak.
	I am concerned that the policy is part of a growing trend of policy making on the hoof. I raised that with the Prime Minister in the Liaison Committee this morning. The policy has not been properly thought through and there has been no proper consultation. Where is our manifesto commitment on it? I was not elected on the basis of foundation trusts; I was elected to get rid of the ethos that is behind foundation trusts. Where is the policy formulation in the party? I discussed the matter with my general management committee and it has not come through for discussion in the policy forums or at conference. Where is the Green Paper? Where is the White Paper?
	We are bouncing to policies that are not fully thought through. The number of Government amendments tabled gives the impression of a policy that has been made on the back of an envelope. I hope that the Government will remove the part of the Bill on foundation trusts and not force us to go against them. They should go back to the drawing board and leave the rest of the Bill to go through the House unchallenged.

Liam Fox: The debate is important. Quite how important depends on which Government view of it we take. The Prime Minister tells us that the reforms are of monumental, historic importance, but the new Secretary of State told Back Benchers this week that the reforms are of little importance so they need not be worried about the amount of change that is being introduced. Both those views cannot be true, unless one is part of the Prime Minister's closest coterie and lives in the Alice in Wonderland world where it is possible to believe two opposites at the same time.
	We have never made a secret of the fact that we favour the principle of foundation hospitals, especially the way in which they have been established in Spain and Sweden. Early in the debate on the Bill, we laid out what we wanted: foundation hospitals that can borrow according to their own plans outwith the limits set by Government; that are free from political interference; that are free from central targets and bureaucracy; and that are free to set the pay and conditions that they think appropriate to attract staff in their locality and with different clinical specialties.
	I realise that that puts me in a diametrically opposed position to the hon. Member for Wakefield (Mr. Hinchliffe), but I have to admit that there is much truth in what he says. The policy is a move back towards an internal market-type system, which we support and would like extended. Indeed, the Government are not moving as far in that direction as we would like. Some people say that we could build on the Bill—were we to inherit it in its current form, we could use it as a prototype to take our plans much further. Indeed, we could and almost certainly would do that, but we believe that there are a number of practical reasons why the system as it has been set out in the Bill is so flawed that it will lead to a much worse system of health care than we have at present.
	What are our major objections? First, there is freedom, but only for a few. Instead of a gradual roll-out for everybody, there is to be a total roll-out for some and none for others, which seems to maximise the potential for instability in the system. If one tried to design a system to give greater instability, it would be difficult to do.
	There is borrowing, but only within the limitation of the NHS budget, which by definition means that if any foundation hospital gets more investment, there will be less investment in another hospital in the NHS. That is different from the case being advanced. The Government will tell us that at present hospitals must compete for a share of the budget, and the proportionate effect will occur anyway. Under the proposals, however, some will be dealt a stronger hand than others vying for the same budget. The whole point of foundation hospitals in other countries was to allow them the freedom not to have to borrow within the state budget, but to borrow from outside, therefore not affecting the total amount available in the public system. The Government seem to have missed the point of the system in Spain and Sweden.
	Another issue is the independence of the system. Great play was made on Second Reading about the independence of the regulator. The term "independence" was not used in a sense that any of us would recognise. The regulator is appointed by the Secretary of State, he can be dismissed by the Secretary of State, his pay and conditions and pension are determined by the Secretary of State, he has to report to the Secretary of State on anything the Secretary of State deems fit, and he cannot grant foundation status except with the prior agreement of the Secretary of State. The system is to be run by the Secretary of State in all but name.
	I have a number of questions that I would like the Minister to deal with when he speaks. The first is about pay. The previous Secretary of State said that managers should have
	"freedom and flexibility within the new NHS pay systems to reward staff appropriately".
	What does "appropriately" mean, in the context of foundation hospitals? Secondly, what does it mean in terms of the Chancellor's new plan, as laid out in the Budget, to introduce regional pay throughout the public services? How would that impact on the proposals for foundation hospitals, and how does it fit with the Prime Minister's pledge last week that all NHS staff will continue, as long as the Government are in office, to have above-inflation pay settlements? How does that relate to the independence of foundation hospitals?

Angela Eagle: I am listening to the hon. Gentleman's comments with interest. Could he tell the House which way his party will vote on the amendment?

Liam Fox: Unless we hear something quite unexpected from the Minister, we will almost certainly vote with the hon. Member for Wakefield in support of the amendment. As I said, there are strong reservations about this part of the Bill.
	We have concerns about governance. Where is the logic in applying any democratic leverage in the system not to the commissioners of health care, but to the providers? If there is a place for local democracy to be involved in the determination of the spending of health funds, it would have been far more logical to bring in election at the level of primary care trusts, where decisions about the commissioning of services, and therefore the spending of funds, will be taken. What is the point of introducing a democratic element into the providers—the hospitals? At that point, they cannot determine what the balance of the provision of services will be, because those decisions will already have been taken by the PCTs in charge of the funding. I find the proposal utterly illogical. It seems to invert the Government's intention.

John Mann: In my area, local people want a say about the future of accident and emergency services. The one hospital in Bassetlaw is part of a larger trust, Doncaster and Bassetlaw. When the decision was made to downgrade Bassetlaw hospital under the current rules, not only were people not allowed to have a formal say, but they were not even allowed to find out about it until decisions were being made. I called a ballot on that and 35,000 people voted—a 60 per cent. turnout. That was not within primary care. What is wrong with that principle?

Liam Fox: That makes the point. The provision and maintenance of services is dependent on the funding of the services. It is the primary care trust that is responsible for the funding of accident and emergency services. There seems to be a dislocation between what the Government said they intended to do, and what they are doing through the Bill. There is no logic in the Government's approach.
	I have a huge problem with the way in which the Government propose to take governance forward. Members of the foundation hospital board will be drawn from the public and the staff. The public members may be those who have attended an NHS foundation hospital as a patient or a carer. On the last two occasions on which we have had Health questions, the right hon. Member for Manchester, Withington (Mr. Bradley) asked about the Christie hospital. At a large hospital with regional and national status, where patients may come from all parts of the country, what will be the constituency if such a hospital became a foundation hospital? Twice Ministers failed to come up with an answer to one of the most fundamental questions about the practical application of the Bill.
	Are we to have a foundation hospital which, because it can draw patients from anywhere in the country, can have hundreds of thousands, and possibly millions, of potential members, and what will the legal requirements be for the hospital trust to ask each of those members whether they want to be elected to the board? The system is supposed to reduce bureaucracy and red tape, according to the Government. It will create a nightmare of bureaucracy and red tape, without even considering the cost.
	Let us consider a simple example—a foundation hospital with a patient catchment of 500,000 patients. Let us assume that one in 10 of the patients in the catchment area might want to be a member of the foundation hospital board at a servicing of between £4 and £5 a year, which is the cost estimated by trusts that have indicated that they might want foundation hospital status. If we add to that the cost of advertising and running the elections, we are speaking of a cost of £240,000 per year per trust simply to maintain and run the electoral arrangements and the foundation hospital board.
	That cannot be what Ministers meant when they said that the public were willing to pay higher taxes to get better quality health care. The public will pay higher taxes, only to see the money diverted on a huge scale into an unnecessary bureaucracy that does not even exist yet. The hon. Member for Wakefield mentioned one of the trust chairmen, who also said that far too much of the time of his management would be taken up preparing and running the consultation process, rather than managing the hospital. All hon. Members must surely have deep reservations about the practical implications, if not the principle, of the proposal.

Gary Streeter: My hon. Friend has spent a great deal of time in the past couple of years speaking to people who run hospitals. How many NHS trust chief executives, consultants, doctors and nurses have said that the real problem with the health service and with our acute hospitals is some kind of democratic deficit? Are not the Government introducing measures that will not improve the health service, and should they not think again?

Liam Fox: Without going into the concept of the democratic deficit, I can say that as a doctor I have never had a patient and as an MP I have never had a constituent coming to complain that they had a real problem with the democratic deficit in the NHS. They usually complain about access to health care. There are arguments to be made about how a system of publicly financed health care is to be made accountable to those who use and pay for the system through their taxes, but the Government's proposals are not a reasonable solution, for the reasons that I have set out.
	I want to mention just one or two other practical implications, as I know that many hon. Members wish to speak. The hon. Member for Wakefield referred to the problem in respect of private income. We believe that what Ministers are proposing has an enormous unintended consequence, as trusts will effectively be limited to the private income that they currently have and will not be allowed to increase it. I have raised the issue with the Minister before and we have still not received a proper answer. The provision will mean that when the new opportunities fund or a charity provides an MRI scanner for a national health service hospital, the foundation trust is prevented from selling to the private sector any spare time when that equipment is not being used to raise greater income. However, the private sector will be able to sell extra time on an MRI scanner to the NHS. Surely, that cannot be what the Government intended. Only a very badly thought out set of provisions would allow that to happen.
	I have one other major reservation. Foundation hospitals are supposed to be set free from central regulation, yet they will be subjected to one of the forms of regulation that I find most ineffective and which is most resented in the health service—the star-rating system. In my constituency in north Somerset, we have five hospitals around us: the Weston hospital, the Royal United hospital in Bath and the three main Bristol hospitals. All those hospitals are officially no-star hospitals. In itself, that is deeply insulting and demoralising to staff, who would like to think that at least some of the services that they offer are high-class services and who resent hugely being rated across the board as having no stars. If there were one thing that might have attracted hospitals out of the current set-up and into the foundation hospital arrangement, it is that they would be freed from that deeply demoralising way of labelling our hospitals. Yet, that one opportunity is going to be denied. In almost every respect, the opportunities that the Government could have taken have been missed. Instead, they have misunderstood what could have been offered and introduced a new series of complexities, bureaucracies and costs that do not exist in the current system.

Evan Harris: I was interested in what the hon. Gentleman said about private income. I think that he has a good point. Does he agree that one approach in tackling the issue is not to set an artificial maximum, but to ensure that the only restriction is that no NHS patient with greater clinical need should wait for a slot that might be given to private, paying patients? Amendment No. 400 deals with that point.

Liam Fox: There are a number of ways of dealing with the practical problem; indeed, some were mentioned in Committee and raised in amendments. I was simply pointing out that there is a perverse consequence in what the Government propose. It cannot be what Ministers intended and such provision will be unworkable.
	Finally, the Office for National Statistics has said:
	"NHS Foundation Trusts are a new type of organisation called a 'public benefit corporation'. . . This set-up has similarities with the model adopted for Network Rail.
	However, the trusts' ability to determine its general corporate policy will be restricted by government's involvement via legislation and regulation. These regulations are many and significant, leaving very little scope for changing the corporate policy of each hospital. The ONS has judged that this involvement is sufficient to determine that the trusts are government controlled."
	It seems that the Government have managed to get the worst of both worlds. What we are going to get is the triumph of Network Rail, augmented by central Whitehall control. And this is progress.

John Hutton: I should like to begin by speaking to the amendment moved by my hon. Friend the Member for Wakefield (Mr. Hinchliffe) and to set out one or two observations about other amendments.

Liam Fox: On a point of order, Mr. Deputy Speaker. As a large number of hon. Members intend to speak, may I ask whether it is normal for the Minister to speak before hon. Members have had a chance to make their voices heard?

Mr. Deputy Speaker: The Minister will be speaking in support of amendments to a Government Bill and it is usual for the occupant of the Chair to call the Minister to speak at this stage if he seeks to rise. Under the Standing Orders, that will not preclude his making a short winding-up speech at the end of the debate.

John Hutton: Thank you, Mr. Deputy Speaker. I genuinely want to be helpful to the House, which is why I thought that it would be useful for me to speak now. If it is more helpful to hon. Members on both sides of the House, I shall confine my remarks to amendment No. 164 and the Government amendments. In the short winding-up speech that I might look forward, if that is the right phrase, to making if I catch your eye, I shall confine my comments to the other amendments.
	I respect the sincerity of my hon. Friend the Member for Wakefield and the strongly held views that he and many other hon. Friends have expressed about NHS foundation trusts, but I believe profoundly that he is wrong in his analysis of the Government's policy and his description of the impact that the reforms will have on our national health service. I shall explain in a moment why I believe that he is wrong, but one thing needs to be made clear at the outset: the Government have listened to the concerns that have been expressed about that part of the Bill, and we have acted on those concerns. We tabled amendments in Committee, for example, to strengthen the accountability to this House of the new independent regulator of NHS foundation trusts. We are seeking to amend and improve the Government's arrangements in schedule 1 to make them fairer and more effective. The hon. Member for Woodspring (Dr. Fox) referred to his concerns, which I shall deal with in a moment. We have ensured that the new national health service pay arrangements will apply to NHS foundation trusts.

Judy Mallaber: I thank my right hon. Friend for giving way. He will know that the anxiety about the issue that he raises is that foundation hospitals could poach NHS staff from other hospitals by offering better pay and conditions. To avoid such an outcome, will he ensure that the newly negotiated "Agenda for Change" applies on the same timetable and basis for foundation hospitals as for non-foundation hospitals and consider further ways of locking in an assurance that hospitals will continue to abide by "Agenda for Change" and national pay rates in future?

John Hutton: I am grateful to my hon. Friend for her remarks. I shall make a few more comments about "Agenda for Change" in a moment, but I understand the point that she makes and have every sympathy with it. That is why I believe that it is important that all NHS foundation trust applicants agree to sign up to "Agenda for Change" as part of the approval process. My right hon. Friend the Secretary of State will not approve for submission to the independent regulator any application from an NHS trust that does not contain that clear and express provision.
	We have made it very clear that the timetable that we envisage for implementation of "Agenda for Change" should be broadly coterminous with the arrangements in the other early implementer sites. I have also made that clear to the trade unions. We recently told trade unions that the NHS foundation trusts will start to apply the new "Agenda for Change" arrangements from this April, should they be set up at that time, but it will be done on the basis of a rolling programme between now and October, so that we can learn the lessons from what is happening in the early implementer sites. If any modifications are needed, they can be made in the NHS foundation trusts as well as other early implementer sites. I hope that my hon. Friend the Member for Amber Valley (Judy Mallaber) will take it from that that my answer to her question is broadly yes, which is what we have said to the trade unions.
	We have also strengthened the audit rules to ensure greater financial transparency. The rules have been the subject of extensive comment both in Standing Committee and elsewhere. We have introduced a cap on the income that NHS foundation trusts can earn from private patients, so that NHS patients will always come first. We have also moved to ensure that the NHS in England will not become a two-tier service, as all trusts will have an opportunity to become NHS foundation trusts in the next few years.

Evan Harris: The Minister says that he insisted on a cap, but did he not table in Committee amendments that weakened the regulator's role in enforcing the cap by transforming it from a duty into a power? The changes also made it clear that the regulator need not enforce the cap in some cases. As far as any concessions were made in Committee, they were made in reverse on the important issue of pay beds and private income.

John Hutton: No, that is completely not the case. In case any hon. Member is confused, let me just deal with that point, because my hon. Friend the Member for Wakefield and others have expressed concern to me about it. The amendments that we tabled in Committee were purely and simply designed to ensure that the ability of NHS foundation trusts to treat patients from Scotland, Wales and Northern Ireland was not compromised by the Bill. That is the sole extent of the changes. Let me make it clear that under clause 15(2) the regulator must impose such a restriction on the amount of private business that an NHS foundation trust can undertake. There is no question at all about that: he must exercise that provision.

George Stevenson: As my right hon. Friend suggests, this is an extremely important matter. Clause 15(1) says that an authorisation "may" restrict. As I understand it, that "may" was inserted in place of "must". How does that strengthen regulation?

John Hutton: As I have tried to explain, we changed the word from "must" to "may" to deal with the issue of whether the trust is treating patients from Scotland, Wales or Northern Ireland; it may not be. I give my hon. Friend this absolute assurance—

Mr. Deputy Speaker: Order. I am sorry to interrupt the Minister, but it would be helpful if he addressed his remarks to the Chair, not behind him.

John Hutton: I am sorry, Mr. Deputy Speaker. It is always nice to look into the eyes of my hon. Friends when trying to be reassuring and tell them how it is. My only other choice is to look at that lot over there. [Interruption.] Well, one or two of them are not too bad, but some of them really do suck.
	The point that I am trying to make to my hon. Friend the Member for Stoke-on-Trent, South (Mr. Stevenson) is that he, like others, has confused the amendments that were made to clause 15(1) with the requirement in clause 15(2) that the regulator shall exercise his powers to impose such a cap. I recognise that it looks on first reading as though there has been a change, but I give my hon. Friend an absolute assurance that the regulator must impose a cap on the volume of private patient activity that an NHS foundation trust is to undertake.

Patsy Calton: Will the Minister give way?

John Hutton: With the greatest of respect, I am conscious that many other hon. Members want to speak, and I am trying to get through my points as quickly as I can.
	These are all significant movements. We have tried to reach a sensible set of positions. The Tories say—we have heard it again from the hon. Member for Woodspring—that we have not gone far enough, and some of my hon. Friends say that we have gone too far. That probably means that we have got it about right.
	In putting forward his arguments against part 1 of the Bill, my hon. Friend the Member for Wakefield made a number of claims. Let me deal with those. First, the claim that NHS foundation trusts will reintroduce the old internal market is not true. That system was based on two-tier commissioning and price competition. Primary care trusts will do all the commissioning in the NHS and, as my hon. Friend well knows, there will be a new national tariff for all hospital services as part of our reforms to NHS finances. NHS organisations will all be paid the same for the same procedures, whether they are NHS foundation trusts or not. Those reforms to NHS finances are all about ensuring that NHS assets are used to maximum effectiveness for the benefit of NHS patients. They are not designed to, nor will they have the effect of, reintroducing the damaging effects of the old internal market.
	In the old internal market, there were no national standards and no independent inspection and audit arrangements. That has all changed. In the old internal market, there was no statutory duty of co-operation between NHS bodies. That has changed, too. The very same statutory duty of co-operation that is contained in the Health Act 1999, and which my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) rightly said would bring the internal market to an end when he introduced the debate on that legislation on Second Reading, is now being extended to NHS foundation trusts. I profoundly believe that it is a myth that these proposals reintroduce the internal market: they do not.
	Secondly, it is wrong to suggest that NHS foundation trusts can gain only at the expense of everyone else. As I have said, there will not be one set of rules on revenue for NHS foundation trusts and another set of rules for NHS trusts; there will be one set of rules for everyone. On capital, we have made several things repeatedly clear. First, there will be proper limits on how much NHS foundation trusts can borrow, which will be determined according to the terms of a prudential borrowing code and their ability to service debt.

Andrew Lansley: Will the Minister give way?

John Hutton: I greatly respect the hon. Gentleman, but I really do want to make my points. Perhaps I will get round to him, although I suspect that he intends to make his own speech.
	Secondly, the independent regulator must take into account the impact of NHS foundation trust borrowing on the wider NHS when he sets their individual borrowing limits. Thirdly, NHS capital budgets are sufficient over the next few years, until every trust becomes an NHS foundation trust, to provide the necessary capital requirements for both foundation trusts and NHS trusts; in fact, there will be a 144 per cent. increase in capital for the NHS in the next five years. So it is not the case that foundation trusts can borrow whatever they like and thereby ensure that every other trust has to go without. NHS foundation trusts will be able to take advantage of a new approach to lending, which means that they can borrow up to their limit without the need to obtain approval from the centre for each investment decision. The new arrangements will be less bureaucratic and less burdensome. It is true that foundation trusts will be able to access capital from public as well as private sources, but these are sensible and reasonable reforms—they are not about robbing Peter to pay Paul.
	Thirdly, foundation trusts are not about a super elite. Over the next four to five years, all NHS trusts will have the opportunity to become foundation trusts. In the meantime, we are investing a further £200 million to improve performance in poorly performing trusts, so no one will be left behind.

Clive Efford: If NHS hospitals are allowed to borrow up to an overall envelope limit, will any additional spending by a foundation trust, whether it comes from the private sector or not, count against other NHS hospitals and therefore limit their scope? If so, foundation trusts will have an advantage over other NHS trusts.

John Hutton: My hon. Friend must take into account one fundamental issue: namely, that foundation trusts are not at liberty to borrow whatever they would like to borrow irrespective of their ability to service the debt. They must be able to service the debt. That, in turn, must be related to the revenue that they have secured through primary care trust commissioning to provide services to NHS patients. As I said, the independent regulator of NHS foundation trusts must, in approving and setting the borrowing limit, take into account the impact of foundation trusts' borrowing on the wider NHS. As elsewhere, we have tried to balance those important new freedoms with some essential safeguards. That is essentially the point that I am trying to make to my hon. Friend the Member for Wakefield.

Evan Harris: Will the Minister give way?

John Hutton: No, I will not.
	Fourthly, my hon. Friend suggested that the proposals will undermine primary care and its emerging role in the NHS. That, too, is simply not true. It is not the case that there is no need for further reforms in the acute secondary care sector of the NHS; and it is possible to implement those changes without compromising on the key role that primary care trusts will have in the NHS in future. The Bill does not change commissioning arrangements: primary care trusts will still lead the development of the NHS.
	Finally, as I said to my hon. Friend the Member for Eltham (Clive Efford), we have tried to balance operational and financial freedoms with the right safeguards, so that the NHS continues to operate as an effective, comprehensive and universal service. All trusts wishing to become foundation trusts will operate the new national pay system—we do not want any unfair poaching of staff—and foundation trusts' actions will be subject to the new arrangements on local public consultation.
	NHS foundation trusts embody a new form of social ownership that provides a much stronger means whereby health services can become more responsive to local needs because local people will have more say over them, as will local staff. We have developed in this country a form of public ownership in which the public frequently feel that they own nothing at all, and in which public ownership has become synonymous with state control. Those are significant problems for all of us who believe in the public service; the Bill provides a solution to both those deficiencies.

Gordon Prentice: Will my right hon. Friend tell me whether individuals who want to become a voting member of a foundation trust will have to pay £1, as specified in the Bill, or merely pledge to do so?

John Hutton: They have to agree to pay up to £1. The provisions of individual constitutions of NHS trusts will be determined and agreed locally through consultation.

Keith Bradley: I shall ask a question about which my right hon. Friend may have notice, since I have already asked it on several occasions. What will be the electorate for a specialist hospital such as Christie in my constituency? Who will be eligible to vote on the governance of that hospital?

John Hutton: I am happy to try to answer my right hon. Friend's concerns, because they are perfectly reasonable and many other hon. Members have raised them. The Christie hospital is a unique asset to the NHS. It is a regional—indeed, national—centre of expertise for cancer services. The Bill requires a public constituency for the NHS foundation trusts, and that must include representatives who are elected from the area in which the hospital provides services. However, in the case of NHS foundation trusts such as Christie's—if it became one—we assume that the majority of the public constituency, especially those elected to the board of governors, would be chosen from the patient constituency, for which the hospital predominantly provides services. That group comprises many people, and we want to work with local foundation trusts to develop the proper mechanism for reaching out to members of the patient constituency and inviting them to become members of the foundation trust.
	Conservative Members today expressed their disdain for the democratic process. They do not want a democratic model of governance for NHS foundation trusts.

Tony Lloyd: Will my right hon. Friend give way?

John Hutton: No, I shall not.
	The hon. Member for Woodspring tried to pooh-pooh suggestions that there was anything commendable in the proposal for patients to have a say in the governance of their local hospitals. He is wrong. It is a fundamental principle of democracy to extend patient choice and involvement in the NHS.

Liam Fox: Before the Minister leaves the subject, what is the answer to the question? What is the patient constituency for a hospital such as Christie? The Minister says that the Government would like to consult about that in future. That pinpoints the weakness of the Bill: it is being made up as we go along.

Hon. Members: Hear, hear.

John Hutton: I note that some of my hon. Friends support the Conservative spokesman on that point.

Liam Fox: They are entitled to disagree with you.

John Hutton: Of course they are all entitled to their views. I have made it clear that I respect my hon. Friends' views. However, the hon. Gentleman sits here day after day, berating the Government for being a command-and-control Administration. He claims that we dictate everything from the centre. In the Bill, we are trying to set a broad structure for local governance, which should be determined and agreed locally, but in a structure of basic guarantees.
	In response to the point of my right hon. Friend the Member for Manchester, Withington (Mr. Bradley) about the governance at Christie hospital, I have made it clear that the majority of the board of governors will be elected from the patient constituency.

George Stevenson: Will my right hon. Friend give way?

John Hutton: No, I shall not.
	For example, patients that the hospital treated in the past three years are eligible. The guide for applications to become an NHS foundation trust sets that out clearly.

George Stevenson: Will my right hon. Friend give way?

John Hutton: I have great respect for my hon. Friend, but I have given way to him once and I must make progress.
	Local consultation will take place and agreement will be reached on the governance issues for each applicant for foundation trust status. We have strengthened schedule 1 today as the result of points that my hon. Friends the Members for West Bromwich, West (Mr. Bailey) and for Ealing, North (Mr. Pound) made in Committee. It provides for an improved framework for local accountability and engagement, and the governance arrangements are clearer and more transparent. The Government have listened and acted on the concerns to which hon. Members rightly drew our attention. The Bill is therefore better and stronger. The Government will accept the relevant amendments that my hon. Friends tabled.
	I believe that the aspects of the Bill that we are considering fully reflect the basic principles of the NHS, and are based on the values of public service. They are not about two tiers, markets, competition or privatisation. Nor are they about change for change's sake or simply another round of NHS reorganisation. The measure is fundamentally about how we can best improve local health services so that the patient benefits.

Howard Stoate: The purpose of the Bill is to give patients more say, flexibility and control over local services. Surely foundation hospitals are merely one mechanism for doing that. We are making a huge amount of fuss about a relatively small reorganisation to allow more flexibility in the running and provision of services.

John Hutton: I agree with my hon. Friend in many respects. The reforms are important but basic, and I hoped that my hon. Friends could support them, especially since they apply to the democratic governance arrangements. Labour Members have always argued that there is a democratic deficit and the Bill tries to remedy that.
	As my hon. Friend said, the measure gives patients a stronger say about what happens in their local NHS and allows local staff to get on with the job of sustaining improvements in the quality of local services. It will take Whitehall out of the daily management of NHS hospitals and help to deal with health inequalities more effectively than the current "one size fits all" model. Local needs and priorities can be better reflected. Giving foundation trusts greater freedom to do the job must be matched by new forms of local accountability, otherwise we could disfranchise rather than empower local people.
	The measures on NHS foundation trusts are based firmly on Labour's traditional values and applying them to today's new world, where people rightly want more personally tailored health care, where their needs should always come first and where everything that we do is judged by one simple yardstick: how will matters be improved for patients? That is why we are introducing the Bill.
	I simply say to all my hon. Friends: do not vote in the same Lobby as the Tories when the future of the NHS is at stake. The Tories want only one simple thing—they want the NHS to fail so that they can peddle their solutions of spending cuts, subsidised private medical insurance and top-up vouchers for those who can afford to go private. It is a policy for the few, not the many. Labour Members should be in the Government Lobby this afternoon, supporting NHS principles and values.
	Let me briefly consider the Government amendments, especially No. 253. It would require NHS foundation trusts to use electoral wards to define their public constituencies. The amendment would provide further clarity in defining boundaries for public constituencies.
	In Committee, concerns were raised that those whom the trust did not directly employ could not become staff members. Government amendment No. 254 would ensure that those people, who have an interest in the organisation because they work there and contribute to its services, could also be members of the staff constituency. That will include, for example, those who work for cleaning contractors when that work has been passed to a private, independent operator. The amendment would also affect our stated intention to ensure that staff on rolling contracts who are continuously employed by the trust for at least 12 months are eligible to become members of the staff constituency.
	Government amendments Nos. 255, 256, 257, 258, 260 and 262 would remove the bankruptcy and criminal conviction exclusion criteria for members and apply them solely to governors and directors. As I said earlier, we shall accept new clause 24 and amendments Nos. 233 and 234, which my hon. Friend the Member for West Bromwich, West tabled. I pay tribute to him for his work to strengthen the Bill.
	Clearly, the process for selecting the representatives of the local community who serve on the board of governors must be fair and transparent. The Bill therefore requires governors who represent patients, the public and staff to be chosen by election. Provided that there is a requirement for contested ballots to be secret, foundation trusts could be allowed to use different forms of voting, such as voting electronically or in person, as set out in Government amendment No. 259.
	Government amendment No. 261 clarifies that representatives of local partner organisations can be appointed to the boards of governors of NHS foundation trusts, as set out in a guide to NHS foundation trusts. Government amendment No. 263 deals with the appointment of a chair, to put the matter beyond doubt.
	The Government will also accept amendments Nos. 242 to 244, which my hon. Friend the Member for Ealing, North tabled. They deal with conflicts of interest. We shall also accept amendment No. 354 on local authority representation on the board of governors of NHS foundation trusts. I am grateful to my hon. Friend the Member for Milton Keynes, North-East (Brian White) for tabling it.
	Opposition Members and some of my hon. Friends intend to move other amendments later. I shall deal with those shortly. Government amendments Nos. 247 and 248 deal with the private patient cap. Earlier, we discussed private patient provisions. I should like hon. Members to accept amendments Nos. 247 and 248. The regulator has powers to set any terms that he considers appropriate to the terms of authorisation under clause 6(3). However, the amendments would make it explicit that the regulator can restrict the provision of non-NHS health care in all NHS foundation trusts, not only those that were previously NHS trusts.
	New clauses 36 and 37 and amendments Nos. 355, 357 and 358 concern mergers. I shall be happy to deal with that issue in my winding-up speech. In Committee, Members drew attention to a deficiency in the Bill, and these technical amendments seek to close the gap.
	In amendment No. 378, the Government propose a change in respect of Wales. Although the Bill provides for the Welsh Assembly to inspect care provided for Welsh patients by foundation trusts, it includes no requirement for it to report matters of concern to the independent regulator. The amendment will allow the Assembly, like the Commission for Healthcare Audit and Inspection, to report failings in trusts to the regulator.
	Part 1 sets out a new direction for the national health service, but it is the right direction. Our proposals are based firmly on traditional NHS values. These reforms are sensible and reasonable. They will help to sustain improvements in the NHS that are now under way. They will give patients and local staff more say over what happens to their local NHS. They will result in a better and more responsive service, so NHS patients will be the winners.
	For all those reasons, I ask my right hon. and hon. Friends to support the Government's proposals.

Evan Harris: When the Government first proposed the establishment of foundation trusts, we examined their plans carefully and compared them with our own policies for NHS reform before considering the likely consequences. For reasons that I will give, we believe that the foundation trust policy is deeply flawed, and, having failed to secure key amendments in Committee, my colleagues and I will vote against it. That contrasts with the position of the Conservatives, who will vote against foundation trusts although, as they themselves say, they support the principle. Some may consider that approach opportunistic—[Interruption.] I believe that it is opportunistic to vote against a proposal when one supports the principle behind it. We have always made clear where we stand, and what our principles are.
	Because of the opportunistic nature of the Conservatives' support for the amendment, Labour Members need not be deterred from supporting it by a fear of being identified with their approach. We will certainly resist that.
	I intend to identify the respects in which the Government's proposals fail to deal with our concerns, and the problems inherent in foundation trusts. I shall then say a little about pay beds. The key flaw in the Government's initiative is its failure to address the issue of NHS commissioning. NHS commissioners—largely primary care trusts—are charged with a duty to plan, organise and purchase NHS care for the populations that they serve by making contracts with those who provide services, mainly hospitals and clinics. There is a desperate need for decentralisation, democratisation and empowerment on the commissioning side of the health service, even more than on the providing side. Primary care trusts are run by doctors and other health care professionals, with a sprinkling of local people on the board. They are not democratically accountable, and have very little discretion because of excessive interference from Whitehall and from Ministers. They cannot raise extra resources from their local populations to expand or improve services, even when there is local consent.
	The best way of protecting and promoting the interests of patients is to give more power to those who are responsible for planning and buying services on their behalf, rather than to those who provide care. We would prefer an approach that created reform by tackling restrictions on the power and freedom of health and social care commissioners.
	We would have liked the Bill to free local commissioners from central political diktat. While retaining evidence-based clinical outcome national standards and tough quality inspections, we would abandon the politically based targets that distort resource allocation and clinical decision making, replacing them with clinical decisions driven by clinical needs. We would introduce light-touch performance monitoring and the auditing of performance against standards. The Government's proposals include no such provision.
	We wanted the Government to replace strategic health authorities and primary care trust commissioning roles with democratically accountable elected commissioners of health and social care at regional and local level, advised by primary care trusts and with a reinvigorated public health function. They would have a legal duty in regard to equity, effectiveness, quality and cost-effectiveness, but would be able to make local decisions. The efficiency involved in electing the same people who are currently elected has already been noted indirectly by the hon. Member for Woodspring (Dr. Fox).
	The empowerment of commissioners would allow them to raise resources locally through a progressive taxation to meet the demands of the local population for a more responsive, comprehensive and high-capacity NHS.
	Sadly, the Government propose no such changes for commissioners, who will consequently have little control over the services that they can develop, despite the rhetoric of "increased devolution to the front line". Indeed, the Bill actually bars commissioners from ever sharing in any of the reforms.
	As for the possibility of a diversity of providers of NHS care, we are committed to a mixed market in provision including the private and voluntary sectors, NHS hospitals and other providers, as long as the care is free at the point of delivery and access is based on need rather than ability to pay. In the not-for-profit sector, we are keen to see the development of mutuals. Although aspects of foundation hospitals are similar to aspects of mutuals, we would allow them greater financial freedoms, and would not allow the freedoms that are given to be exercised at the direct expense of non-mutual NHS hospitals. We would not impose mutual status on a few hospitals, or "award" it to them; we would allow all hospitals to consider whether they wanted such status. We would consider it to be different from, not better than, the status of other NHS hospitals.
	The way in which the Government propose to award foundation status to three-star hospitals is extremely divisive—especially given that the star rating system does not measure good clinical care, higher quality or meaningful patient outcomes. It measures performance, or statistical massage, against a series of political targets which, if anything, threaten good patient care by distorting resource allocation to areas that are outcome-measured and distorting clinical decision-making.

Gordon Prentice: In what respect are foundation trusts mutual organisations? Having asked the Minister about that, I was told in a parliamentary answer yesterday that he would write to me as soon as possible.

Evan Harris: It is in the context of staff representation on governing boards that we consider the Government's proposals vaguely similar to our proposals for mutuals. I think there is merit in those proposals, regardless of what happens on the commissioning side. If that were all that the Government were proposing, without some of the other problems, we would be minded to support it—and in Committee we did not oppose such measures. When the Government announced amendments to extend the franchise of the staff side to people in ancillary roles, often low-paid, who have worked for a hospital all their lives but whose service has been contracted out, we tabled our own amendment in Committee and the Government accepted it. We have worked to make these hospitals more like the mutuals that we want to see, but unfortunately we are still not satisfied.

Andy King: Surely it is possible to put staff representatives on the hospital boards without creating a huge two-tier economy.

Evan Harris: I agree. That would have been an alternative approach for the Government and for us. We still think that providers should be allowed to seek mutual status, but we do not think that it should be imposed or awarded, or that there should be electoral nonsenses.
	I hope that the Secretary of State or the Minister will tell us why, despite our many attempts to establish the facts, the Government have still not provided a shred of proper evidence that the high-level targets or performance indicators—such as the numbers on waiting lists, or the two-week wait—on which they base their award, or reward, of three-star status have any basis in clinical outcomes. I ask the Minister to provide that answer, because he has never done so before. The "Panorama" programme that focused on my local hospital in Oxford identified exactly how patients are put at risk by the imposition on managers of the need to meet these targets. The trauma surgeon Keith Willett, who works at the John Radcliffe hospital, showed how the need to treat the least urgent patients within a maximum time limit often means that treatment of patients whose needs are more urgent is postponed, to their detriment. The Government have not responded to that point; indeed, they refused to address the questions raised in the "Panorama" programme. Until they ditch such politically based performance indicators, their approach will have no support from health care professionals or, even more important, from patients and those who represent them.
	The Government propose a sham democracy for foundation hospital trusts, in which local members will elect a few people to the board of governors. This is clearly a far less effective method of ensuring proper democratic accountability than our proposal properly to democratise, through the electoral roll franchise, the commissioning side of the NHS. Although there is certainly merit in the public's having a stake in major local providers, this should not be seen as an alternative to, or rival to, proper, democratically accountable commissioning. A pseudo-democracy like that proposed in this measure creates the real problem of a parallel franchise, rivalling local, democratically elected councillors. The resulting confusion would actually damage accountability.
	We would prefer—we proposed amendments in Committee to this effect—a stakeholder-type board for mutual hospitals, representing staff and the community. The interests of patients and the public are more powerfully represented by elected commissioners and by patients forums. The Government proposed to set up patients forums as a replacement for community health councils, but they now propose to ditch them in respect of foundation hospitals, and, in due course, in respect of all hospitals, because all hospitals will be foundation hospitals.

Patrick Hall: Will the hon. Gentleman give way?

Evan Harris: Yes, I will give way to the hon. Gentleman, who chairs the all-party group on community health councils and may well be keen to catch your eye, Mr. Deputy Speaker.

Patrick Hall: I thank the hon. Gentleman for giving way. Does he not agree that not having a patients forum on a foundation hospital trust would remove that element of independence that is crucial to the new system of patient and public involvement in the NHS?

Evan Harris: The hon. Gentleman is right, and given his experience of talking to the people involved in patient and public representation, the Government would do well to listen. I invite him and others to look at new clause 9, on page 2,489 of the amendment paper, which is tabled in my name. When this issue was debated in Committee, there was support for the proposal from both sides of the House, and the hon. Gentleman makes a very good point. It is impossible to secure the interests of patients simply through the efforts of those who run hospitals. That creates a conflict of interest, and with the best will in the world, those who try to exercise the dual roles of defending and supporting hospital management and representing the views of patients would find it impossible to juggle them.
	I urge the Government, even at this late stage, to say that they will support new clause 9. After all, when they abolished CHCs—in itself a highly controversial measure—their defence was that patients forums would roam further than CHCs, not only examining the commissioning side but being active on the provider side. Now, the Government propose that there be no patients forums in any hospital. The hon. Member for Wakefield (Mr. Hinchliffe) strove hard with many of us to secure amendments to initial Government proposals during the previous Parliament, and to secure amendments to an earlier Bill in this Parliament under which the Government proposed to abolish CHCs. He must share my disappointment that the Government intend that if foundation hospital measures are adopted—I accept that he hopes they are not—there will no longer be patients forums in hospitals. That raises questions about the Government's good faith in making the concessions that they claim to make in abolishing CHCs.

Liam Fox: Are the hon. Gentleman's anxieties about the lack of patients forums diminished or heightened by the fact that the Government, through one of their own amendments, are moving away from the concept of postal votes and potentially towards electronic voting, which might further disfranchise patients?

Evan Harris: That may well be a problem. The electoral arrangements are likely to be not only a parallel franchise, as I said, but a dog's breakfast. The Government's saying that they are simply going to leave the matter to the constitution of foundation trusts gives no comfort to those of us who think that it will be impossible to find a clear way out of this mess.
	In terms of foundation trust status, it seems that the Government's motto is: "To those who have, more shall be given, and from those who have not, it shall be taken." In Committee, the Government effectively admitted that because any borrowing by foundation trusts, using their greater licence to do so from the private sector, would be set against the total amount of capital available to the NHS, any extra ability to borrow—and any extra borrowing achieved from the private sector for foundation trusts—will by definition reduce the pot of money available for non-foundation trusts. If the Minister looks at the record, he will see that the Government simply did not address that point, either in answer to me or to the hon. Member for Birmingham, Hall Green (Mr. McCabe), who is no longer in his place.
	I invite the Minister to explain this at the Dispatch Box today: if the total amount of NHS capital is limited and any borrowing by foundation trusts through their increased licence to do so will be taken from that total, how will that not by definition reduce the amount of capital available for the second wave of borrowers—those with less power than non-foundation NHS trusts? [Interruption.] The Dispatch Box remains empty, and as happened in Committee, no answer is given, for the reason that there is no answer to that problem. It is the inevitable consequence of the decision to ensure that such borrowing is against the pot available.
	There was an alternative, which was not to go down this path at all, or even to allow such borrowing to be set against expenditure limits. Unfortunately, the Government chose not to do so, and the result is a policy that robs Peter to pay Paul. Our proposals for mutuals would have allowed additional private borrowing without its counting against Treasury limits for borrowing in the health service. In addition, we would not have proposed that the sale of assets by foundation trusts—those that are allowed because they are not necessary for core service—be available only to foundation trusts, rather than to the NHS as a whole. I suspect that other Members will make that point in more detail.
	We are not opposed to foundation trusts because we think that everything has to be the same; there can be a mixed market in provision. In the Liberal Democrats' opinion, the NHS should be free at the point of delivery, as comprehensive and universal as possible, and based on need rather than the ability to pay. In that respect, who owns or runs hospitals is not important, so long as they guarantee equity, quality and other essential factors. We are not opposed to foundation trusts because we think that they amount to quasi-privatisation of the NHS. Such privatisation is far more likely to happen through a version of the patient passport policy proposed by the Conservatives. Although we do not consider foundation trusts to be a direct route to privatisation, private care issues do arise, particularly in relation to pay-beds.
	As has been pointed out, in Committee the Government weakened the provision relating to the cap on private income. The Minister may say that it was not his intention to do that in changing "must" to "may" and "duty" to "power", but on an issue as important as this the phrasing should have put the matter beyond doubt. I invite him to do so, and if he is unable to give such reassurance, those of us who are concerned that that cap guarantee is not worth the paper that it is written on will not be reassured by his approach.
	Amendments Nos. 397 and 398 seek to reverse the changes made in Committee, and amendment No. 400 makes it clear that there should not be arbitrary limits on pay-beds. People should not occupy pay-beds in the NHS if there are NHS patients with greater clinical need. We know that NHS waiting lists are far longer than private waiting lists, and that beds and precious capacity in the health service are given over to private patients. I urge hon. Members to consider amendment No. 400, which would ensure that, regardless of any arbitrary limit on private income, NHS patients are not badly treated.
	New clause 39, also tabled by the Liberal Democrats, urges the Government to accept a proposal whereby overview and scrutiny committees and patients forums have to be consulted before approval is given.
	Finally, the Government did not deal with Government amendment No. 356. As far as I know, the Minister did not mention it as he rattled through the list. That amendment proposes that the Government underwrite external loans taken on by foundation trusts. Will that not give even more power to foundation trusts to loan against the limit that is shared by non-foundation trusts? I invite the Minister to tackle that issue now.

John Hutton: I do not wish to detain the House, but the hon. Gentleman is barking up the wrong tree. [Hon. Members: "Barking?"] In line 1, page 1, before "up the wrong tree" leave out "barking". The amendment to which the hon. Gentleman refers deals with the private finance initiative. We need to find an appropriate mechanism to support PFI deals in NHS foundation trusts. That is all that the amendment does, and that PFI borrowing does not score against the prudential borrowing limit.

Evan Harris: This is the amendment that dare not speak its name—[Interruption.] The Minister conveniently forgot to mention an amendment that approves the ability of foundation trusts to close PFI deals.
	In summary, for the reasons that I have given, we oppose the Government's proposals for foundation trusts. I hope that they fail today and I urge hon. Members to join me and my colleagues in opposing them. I also urge them to consider the need, if foundation trusts are approved, to secure adequate means of patient representation through patients forums. If I have the opportunity to move new clause 9, I hope to preserve patients forums on the provision side of the health service.

Frank Dobson: Out of courtesy to anyone who wants to intervene on my speech, may I use a clinical expression that I picked up as Secretary of State for Health? I have done my back in, so if I give way and sit down, I may not be able to stand up again.
	The Government's various concessions do not deal with most people's fundamental objections to the concept of foundation hospitals. Those hospitals will impose an unwelcome and unnecessary reorganisation of the NHS, which will consume much money and a great deal of senior management time. Advantages will be given to one group of hospitals at the expense of another. Foundation hospitals will be allowed to set their own strategy and priority, taking that role away from local primary care trusts. Competition and the spirit of competition will be reintroduced to the NHS. All that is being done, we are told, in the name of less Government interference.
	We do not need to reorganise the NHS or change the law in order to reduce the amount of ministerial interference. All my right hon. Friends need do is stop interfering—[Hon. Members: "Hear, hear"]—and they should stop interfering in all hospitals, not just a limited number of them. I confess that I did some interfering myself as Secretary of State, but by the time I resigned, I believed that there was too much interference and too much earmarking of funds. I am afraid, however, that that development has continued rather than being reduced, and we need to reverse that.
	It is also said that the proposals will give local people a sense of ownership of their local hospital because they will be able to vote for the governors. We have to recognise, first, that the NHS is the most popular institution in this country. If we ask people about their local hospital, local town hall or local MP, I know which is most popular with my electorate—let alone anyone else's. They have a higher opinion of the hospitals that serve them than they do of my excellent council, or even of me. The fact of election will not necessarily give local people a sense of ownership or increase the popularity of the health care that they receive.
	I know that the Government would never be swayed by anything to do with opinion polls, but they may be aware of the work carried out for the Audit Commission, which asked people whether they would like a bigger say in the running of their local hospital. In that survey, 22 per cent. said yes, and more than 50 per cent. said no, so it is not even popular with the people who are going to be enfranchised.
	We are told that hospitals will receive more money, more beds and more staff. That is right, but all hospitals are getting more money, most will increase the number of beds and most will increase the number of staff. That is the crucial change that the health service needs, because for decades we have expected the service to go on with too few doctors, nurses, midwives, therapists and everyone else. That is the fundamental problem. The Government's 40 per cent. increase in the intake of students to medical schools is a huge step in the right direction, but it will be a long time before it produces great benefits.
	In the absence of sufficient staff, the NHS has been exposed to reorganisation after reorganisation until the people working in it are sick to death of reorganisation. They know that every process of reorganisation distracts the people working in the health service from their proper and chosen job of looking after patients. It takes up money and, above all, it takes up time. It is safe to say that as we debate this proposal, the 32 applicant foundation trusts will be having one of their innumerable and endless meetings about how to progress their application for foundation status. We know that every hour they spend on that aspect of reorganisation is one less hour spent on helping clinicians to help patients.
	As my hon. Friend the Member for Wakefield (Mr. Hinchliffe) said, we have had 18 reorganisations in the last 20 years. Some people are now saying that extra money, extra staff and extra beds are not delivering the improvements that we want. Well, I can tell them this: the 18 reorganisations certainly did not deliver the improvements that were wanted. Given some time and the opportunity to let the changes bed down and to make good use of the additional resources, the NHS will improve, as it is already improving.
	It is suggested that those who are opposed to the structural reorganisation are opposed to change and improvement in the health service. I do not use the word reform. Reform is a word that gets up the nose of virtually everyone who works in the health service and it does not impress the public. People working in the health service want to improve it. They want to improve what is happening in their clinics, their operating theatres and their surgeries—and they are getting on with it. However, if we introduce foundation hospitals, some of them will find it easier to get on with it than others, because those hospitals will be given advantages over the others. That fact cannot be denied.
	I think of my own constituency. University College hospital, a wonderful hospital in my constituency, is going for foundation status. If it gets that status, it will get more money. If it has more money, what is it going to spend its money on except improving the pay and working conditions of its staff? There is nothing else for it to spend the money on. If it improves the pay and working conditions—by working conditions, I include acquiring new equipment that does not go on the blink as the existing equipment does—it is bound to attract staff from the Royal Free, the Whittington, St. Bartholomew's or Great Ormond Street: other hospitals that also serve my constituency. They will be put at a disadvantage, so University College hospital will get better at the expense of the rest.
	Nothing that Ministers have said will prevent that happening. They tell us that "Agenda for Change" will apply to all hospitals, but that needs money, and those with more money will be able to implement the agenda quicker. If they feel like it, they will be able to upgrade a post—they have the money to do it—and then attract someone to fill it. That is made clear—unless the Government were being misleading originally—in the Green Paper, which says that the extra funds would allow hospitals to offer new rewards and incentives to staff. That means more money and better working conditions.
	I am also concerned about the registers of electors to the boards. Some of the big teaching hospitals will have more than 2.5 million people on their register of electors—if they can put one together. Who will qualify? We are told that it will be people living in the locality, and anyone else who has made use of the hospital. However, we know that the hospitals will get it wrong. Compiling a register is a very complex process and it is a safe bet that within a few months the hospitals will have 20 old ladies who regularly visit a clinic saying that they have been left off, and someone from Doncaster who went into A and E on a once-in-a-lifetime visit will be entitled to vote. We know that that is bound to happen.
	In addition, compiling the register will be astonishingly expensive. Local authorities annually spend £50 million making the minor incremental changes to their existing registers, even though they employ staff who are familiar with the problem and know how to do it. It costs another £20 million to organise local elections. Do most people think that that is the best use of the next lot of money for the NHS? Or would it be better spent on patients?
	Patient confidentiality is another issue. Most hospitals do not put their name on the envelope when they send people letters, because many people do not want anybody to know that they are going to hospital. They do not like their employer knowing and often do not even like another member of their family knowing. However, if someone is on the register, everyone will know. The British National party will have access to the register and know who has gone to hospital. How will Asian people—for example—fancy the idea of the BNP trying to exploit their hospital attendance in some racist way, such as claiming disproportionate use of hospital services?
	What will happen to the primary care trusts? They were established, with the full agreement of the professions, to involve the GPs, community services, local nurses and social services in laying down the priorities and strategies for health care in their area, based on an analysis of their day-to-day experience. That would assist in placing proper demands on the local hospitals. However, that role will now be taken back by the foundation hospitals. All the documents say that the foundation hospital governors will establish the strategy and priorities for their hospital. So foundation hospitals will be the cuckoo in the nest, and that is why the Royal College of General Practitioners joins the BMA and virtually every other health service organisation—including the main health service unions—to oppose the proposition.
	I cannot agree with my right hon. Friend the Minister of State, Department of Health—and he is my good friend—that this proposal does not reintroduce competition and will not set hospital against hospital. It will. Its whole philosophy is to get hospitals competing with other hospitals down the road. That was a disaster when the Tories introduced it, because co-operation came to an end. I remember going with my hon. Friends the Members for Hampstead and Highgate (Glenda Jackson) and for Islington, North (Jeremy Corbyn) and my right hon. Friend the Member for Islington, South and Finsbury (Mr. Smith) to talk to the chief executives in our area when the internal market was at its height. We pleaded with them to co-operate on something—I cannot remember exactly what—but one of the chief executives said, "Oh, we can't co-operate now, Mr. Dobson. It's dog eat dog in the health service now." We do not want that atmosphere back.
	We know that competition increased bureaucratic costs and that waiting lists went above 1 million for the first time. The only serious academic study of the impact of competition of the quality of care was done by Bristol university, which looked at figures from all over the country for recovery rates for people who had gone into hospital following a heart attack. The summary of their findings stated:
	"Our central finding is that competition is associated with high death rates: in other words competition is associated with lower quality."
	We do not want competition or lower quality.
	I have addressed the damage that foundation hospitals are likely to do to the health service. I confess that, as a Labour party member, the damage that the policy will do to the Labour party bothers me just as much. Almost everybody in the labour movement is opposed to this proposition, and their instincts are right. It was suggested to me on the radio the other day that perhaps the leadership of our party did not want us to speak up against foundation hospitals because it looked as though we were the party of the producer. If the producers are the doctors, nurses, midwives and therapists—the people who actually provide the care for the patients—I would rather be on their side than on that of faceless think-tanks and advisers, who seem to think that the world can be transformed with the click of a laptop button. If I must choose between the laptoppers and the producers, I am with the producers.

Andrew Lansley: I have two groups of amendments in this gargantuan group, and I shall refer to them briefly and to the general proposition, as advanced by the hon. Member for Wakefield (Mr. Hinchliffe). I am grateful to him for his kind comments. If I know anything about the NHS, it is in part due to serving under his chairmanship of the Health Committee, and in part to my father. On the day on which the NHS was created, my father was working for London county council, running a health service laboratory. He worked for the NHS for the next 35 years and became chairman of the Institute of Medical Laboratory Sciences.
	There are Conservatives—including my hon. Friend the Member for Woodspring (Dr. Fox)—who have worked for the NHS, and who would resent the way in which the Minister referred to our intentions. Our intentions are to try to create an NHS that delivers more and better quality health care for the people of this country. We may have different views on how to achieve that, but I hope that the Minister will not dispute that that is our intention.
	Some of us will also join the hon. Member for Wakefield in resisting the structure of foundation hospital status, as the Government propose it, for different reasons, but with the same intentions. We will not have many opportunities in the next year or so to discuss the structure of the legislative framework for hospitals, so we have to get it right. Behind some of my amendments is the desire to get the structure right this time.
	My first group of amendments runs from No. 154 to No. 161 and relates to the possibility that a combination of NHS trusts might wish to apply for NHS foundation status. The Minister mentioned Government amendment No. 357 and new clauses 36 and 37. I am grateful to the Government for tabling those provisions, because they will allow foundation trusts and NHS trusts to apply for authorisation as NHS foundation trusts by way of a merger. The previous structure of the legislation implied that one NHS trust equalled one NHS foundation trust. We discussed the issue on Second Reading and again in Committee, and Government amendment No. 357 and new clauses 36 and 37 remedy that deficiency, so I am happy that the Government have tabled them.
	The other group of amendments that I wish to speak to begins with amendment No. 96, but its essence is contained in new clauses 19, 20 and 21, which would introduce the concept of NHS community trusts alongside the foundation trusts.

Siobhain McDonagh: Will the hon. Gentleman support the application of Addenbrooke's hospital in his constituency for foundation status? If so, why would he vote against them today?

Andrew Lansley: The hon. Lady anticipates a subject that I was about to discuss. I have already said that I would support the applications by the Addenbrooke's NHS Trust and Papworth Hospital NHS Trust, both of which are in my constituency and both of which are applying for NHS foundation status. Whether there is a foundation trust status in the form proposed available for them to apply for will, of course, depend on the decisions of the House.

Claire Ward: But the hon. Gentleman is voting against the Bill.

Andrew Lansley: I am answering the hon. Member for Mitcham and Morden (Siobhain McDonagh). If the hon. Member for Watford (Claire Ward) wishes to intervene as well, I will gladly give way.
	I will support Addenbrooke's because it is an excellent hospital at the leading edge of medical research, clinical practice and innovation in the NHS. The view of the trust, with which I agree, is that it wants to be at the leading edge of innovation within the NHS, wherever the NHS is going. If the Government tell Addenbrooke's that NHS foundation trust status is the way forward for the NHS, Addenbrooke's will go along with that, and I will support it. On each occasion that it has acted in a similar manner, resources have tended to flow from that decision. The word that we have not yet heard is "capacity". Addenbrooke's NHS Trust is running at about 95 per cent. bed occupancy now, and if it is to be able to increase capacity to serve my constituents, it will have to be at the leading edge of the NHS.
	Papworth Hospital NHS Trust is a complementary case. It is a heart and lung hospital, and the fastest growing hospital in the country. It, too, needs to increase capacity. It did not succeed with a private finance initiative bid in 1998, shortly after the Government came to power. I want that trust to be able to undertake its necessary capital projects. As things stand, it could do that in one of two ways: through PFI or by borrowing the money from the Department's facility. This has not previously proved an easy bid to finance through PFI, but it might well be able to arrange that borrowing through the departmental financing facility as extended in the Bill. It might also be able to do so on better terms, given that it would be doing so at the national loan fund rate.
	I am a practical person. If the legislation is in place, I will support my hospitals in using it to their best advantage. I would like to be able to persuade the Government to introduce legislation that offers genuine freedoms to NHS hospitals, providers and commissioners. My purpose in voting with my Front-Bench colleagues today will be to tell the Government that they need to introduce such legislation. I shall give way to the hon. Member for Stoke-on-Trent, South (Mr. Stevenson), who has previously been denied that opportunity by his Front-Bench colleagues.

George Stevenson: The hon. Gentleman says that if foundation hospitals become a reality, he will support Addenbrooke's because the resources would flow from that decision, but will he have a care for my constituents, who will not benefit from the first wave of foundation hospitals and are likely to lose out as a result?

Andrew Lansley: I am not sure that the hon. Gentleman's constituents will necessarily lose out in that way. The Minister would not give way to me earlier, but I wanted to make the point to him that he is trying to tell the House that NHS foundation trusts and NHS trusts are on all fours. They are not. For example, he has not yet told us what he is going to do about year-end surpluses in relation to NHS trusts. I want Addenbrooke's, which has resolved its deficit problems and which, with the national tariff, will be able to generate a surplus, to be able to carry over that surplus at the year end. As an NHS foundation trust, it would be able to do so. The hon. Gentleman's constituents would not necessarily lose out as a result of that flexibility, however. It is in the Minister's gift to get up now and tell us that he will offer year-end surplus transfers to all NHS trusts. If he does so, fine. We would then be nearer to the point at which every trust would be the same.
	So far as borrowing is concerned, there could be a difference between NHS trusts and NHS foundation trusts. That will entirely depend on the Minister making an assertion that, during the years that foundation trust status is available only to some hospitals, the Department's ability to finance their borrowing will not constrain the availability of capital for the others.
	I have departed from my main point, and want to return to the amendments. In the event that the House decides to proceed with NHS foundation trust status, and not to reject it at the instigation of the hon. Member for Wakefield, an important second question will arise. Should foundation status—the mutualisation and local ownership of decision making in the NHS—be confined to hospitals, or should it be provided to the commissioning bodies, the primary care trusts? My hon. Friend the Member for Woodspring and the hon. Member for Oxford, West and Abingdon (Dr. Harris) both said that the latter proposal was entirely desirable. The Select Committee report referred to the evidence of many witnesses who suggested that it was not only desirable but arguably the logical place to start with such measures.
	The Government responded to the Select Committee report yesterday, and their attitude seems to be "Make us virtuous, O Lord, but not yet." They say:
	"the Government is open minded about the possibility of a wider democratic option for Primary Care Trusts, but remains of the view that Primary Care Trusts must be given time to mature as organisations before this option is explored further."
	We know what that means. It could be many years before new primary legislation is introduced to give primary care trusts, as commissioners, the opportunity to be locally owned.
	The purpose of new clauses 19 to 21 is to introduce a community trust status that would apply to primary care trusts and enable them to become locally owned. I hope that the proposals are carefully drafted, and they incorporate certain safeguards. As with NHS foundation trusts, PCTs would not be able to apply for community trust status until the Secretary of State had given his approval for them to do so. He would, therefore, still have a block on the speed at which they could apply.
	It is not possible simply to add PCTs into foundation trust status, because the form of the constitution is not precisely right for that. The way in which the community trusts are written into the amendments and new clauses would stress to a greater extent the proper role of the staff constituency and set a minimum of one third of the membership of the board of governors for the staff constituency. In making this transfer, we would be asking general practitioners and other primary care professionals to hand over a significant part of their current control over primary care trusts to the local public. We would therefore put in place a mechanism, which I hope the House will accept, to offer that choice. It is vital that we do so, otherwise it may be many years before PCTs have the chance of local ownership, and during that time the balance will shift dramatically in the NHS. It is important that that balance continues to be geared towards primary care, as we are seeking a primary care-led NHS. I shall use my locality as an example.
	If there is a dominant hospital in Addenbrooke's NHS Trust with a multiplicity of primary care trusts acting as commissioners and if, at the same time, the NHS trust has a large local membership that believes that it owns Addenbrooke's hospital, not only does the PCT have less power in relation to the NHS trust than it used to, but it will be perceived locally as being less locally owned than Addenbrooke's hospital. When questions of priority come to the fore, people will expect the hospital, rather than the PCT, to be their voice which, to me, seems the wrong way round.
	If amendment No. 164 is not accepted, I urge Members to support my amendment. I hope that my colleagues will do so, as well as Liberal Democrats, in the light of the speech of the hon. Member for Oxford, West and Abingdon. I believe that the right hon. Member for Birkenhead (Mr. Field) and the hon. Member for Hornchurch (John Cryer) tabled amendments with a similar aim to mine. I hope that all hon. Members will regard amendment No. 96 and the linked amendments as a way of injecting such proposals into the legislation.
	I answered the question of the hon. Member for Mitcham and Morden about the two hospitals in my constituency, but I wish to deal in more detail with the principle of NHS foundation trusts. Essentially, my objection to the Government's proposals is not about the principle of such trusts; as my hon. Friend the Member for Woodspring said, we support the principle of foundation trust status. We favour freedom for NHS providers to manage themselves and respond to local priorities, rather than being subject to central control. The problem is that the Bill simply does not offer that. We know that NHS trusts will be tied to the "Agenda for Change" on pay and conditions. Addenbrooke's is happy with that but, in principle, managers should be free to vary them. Trusts will be subject to a national tariff but, if they want to maximise the utilisation of capacity, they ought to be able to discount the cost of capacity so that they can use spare capacity.
	Nobody has mentioned the NHS information technology strategy. Most providers, including hospitals, are clients of IT companies. NHS foundation trusts will be subject to the entire NHS IT strategy, but will not be direct clients of IT companies. Instead, regional bodies will be the clients of IT providers. Trusts will be subject to PFI. The Minister reminded us that Government amendment No. 356 reinforces the fact that PFI will operate in exactly the same way for foundation trusts as for NHS trusts. Foundation trusts will also be subject to the same overall departmental expenditure limit as other NHS trusts. The freedoms that I seek, including the freedom from bureaucracy, are simply not present in the Bill, so I cannot support the introduction of foundation trusts, because the rhetoric is simply not matched by the reality. I shall therefore press amendment No. 96 to a vote.

Adrian Bailey: I shall speak in support of new clause 24 and amendments Nos. 233 and 234, which I tabled. First, however, I should like to declare the fact that I am vice-chairman of the Co-operative group in Parliament, and a lifelong supporter of the principles of mutuality and co-operation in the delivery of our public services.
	Before I discuss the substance of the amendments, I should like to pick up a couple of points. First, many Members have spoken about the running costs of any form of democratic involvement in foundation hospitals. Various mutual and co-operative organisations have developed low-cost, effective means of communicating with their members, and I know that the movement would be happy to make its expertise available to any prospective foundation trust. Secondly, there is nothing intrinsically socialist about the present Whitehall-driven NHS. The debate about local control and mutuality in the health service went on for many years before the NHS was founded in the 1940s. The current model was not arrived at because it was intrinsically egalitarian or socialist—it was the result of horse-trading between the Labour Government and health professionals in the 1940s.
	I have tabled these amendments because I recognise that legitimate concerns were expressed on Second Reading and in Standing Committee about the commitment of foundation hospital trusts to democratic participation, and because the provisions in the Bill appear a little vague. New clause 24 would place a legal duty on foundation hospital trusts to take steps to secure a membership that is truly representative of the local community. Amendment No. 233 stipulates that, to obtain authorisation, a foundation hospital trust must be representative, and amendment No. 234 would place an obligation on trusts to report annually on the steps taken to achieve that.
	My prime objective with the amendments is to ensure that the full potential offered by this new form of governance is realised. I believe that the democratic responsibilities of the trusts must not be subordinated to the other freedoms that foundation status will bring. The amendments define more clearly the obligations of applicant trusts to democratic ownership and control. To achieve foundation status, an applicant trust must demonstrate that it is as committed to local accountability as it is to gaining freedom from Whitehall.
	In the debates on Second Reading and in Standing Committee, concern was expressed that the proposed membership arrangements could be open to abuse. One fear was that a highly organised religious group might hijack a governing body to demand that the clinical priorities of the hospital be changed in accordance with its religious beliefs, irrespective of the views or needs of the local community.
	Another concern was that the governing body would be dominated by representatives of the so-called sharp-elbowed middle classes. It was feared that the professional, better educated and more self-confident members of the local community would be more skilled at using the democratic machinery, and that the views and principles that they expressed would take precedence over the interests of the less educated and more inarticulate members of the community.
	The amendments are designed to stop that. However, they are not just defensive: they are also designed to promote social inclusion. My constituency is fairly representative of a large number of inner-city areas. It has a high percentage of elderly people on low incomes who do not have cars. They spent their lives in local industry and suffer from a range of conditions related to a hard working life. We also have a substantial ethnic minority population. Many of them are first-generation immigrants, with limited language skills but considerable health needs.
	Such people could be excluded from participation by hidden barriers that are not directly or deliberately erected by a hospital trust. Those barriers could exist because the trust's governors are not sufficiently representative, or because their understanding of the measures that need to be taken to ensure full participation is incomplete. Ironically, it is the elderly and disabled—the ones with the most pressing health care needs—who could be the ones least able to play a part in a service on which their quality of life might crucially depend.
	My amendments would ensure that the elderly, the disabled and the disadvantaged are heard. As a condition of the granting of foundation hospital status, credible steps must be taken to ensure that all views are incorporated into hospital governance.
	The Bill's provisions represent a dramatic change from the centralised, Whitehall-driven control of local hospitals that has developed since the formation of the NHS. I accept that they pose an enormous challenge for management and represent a change in working culture.
	The current management trusts appointed from local applicants are a recognition of the need for local input into hospital management. Many of the trusts are staffed by able and dedicated people, but they are not directly accountable to the local public. They amount to little more than a genuflection in the direction of local participation.
	Currently, hospital management has no track record of democratic involvement. That lack of experience means that there is a danger that the mechanism of member involvement will not achieve its full potential. The last thing that we want is an incomplete and rudimentary form of member participation that enables a coalition of the great and the good in the local community to perpetuate its control of the trust by a form of mutated democracy. That would be no more than a sort of quango with votes on.

Siobhain McDonagh: Is my hon. Friend aware that my constituency is not represented on the board of either St. George's hospital or St. Helier hospital, both of which serve my community? It is not represented on the primary care trust and, so far, it has been excluded from all centres of power and the limited democracy in the health service. Does he agree that foundation hospitals will give some of my constituents a chance to be represented on those boards?

Adrian Bailey: My hon. Friend raises a valuable point. Local membership would give the opportunity to elect people to the governing board, which would effectively represent their interests.
	I believe that Ministers share with me the intention that foundation hospitals should be genuinely mutual. The amendments detail the obligations of the trust, and provide a mechanism by which the means and level of membership recruitment can be measured to ensure that the boards are truly democratic.
	The amendments are positive; they are designed to extend and promote the principles already incorporated in the Bill. They will provide a record of best practice and achievement that can be shared by everyone and passed on to subsequent generations of applicants. Furthermore, as democracy develops and becomes more successful, the model could be transplanted to other NHS services.
	I take the point that has been made about PCTs. However, if we are to pioneer a new form of democratic participation in the health service, it makes sense to do so where the local community has the strongest identity and interest, which is undoubtedly at the local hospital.
	The proposals offer the opportunity for a whole new constituency to engage in the running of our most valued public service. Few institutions arouse more justifiable loyalty and regard than the local hospital. By giving local residents, patients and employees a say in the running of their hospital we are both pioneering new forms of public participation and providing a means of educating people about the structures, policies and priorities of the service. We shall also be educating administrators on the wishes and aspirations of the local communities, and making them accountable in a way that might lead to a refinement of established practices better to meet the needs of their constituents.
	Developing the bond between the public and their local hospital opens new possibilities for voluntary support and recruitment to add value to the hospital's existing work. In his Second Reading speech, my right hon. Friend the Member for Birkenhead (Mr. Field) talked of the potential that could be unlocked. Once people feel that they own and control their local hospital, who knows what extra efforts they will make to support it? Above all—

Glenda Jackson: Will my hon. Friend give way?

Adrian Bailey: I am about to conclude my speech; I am conscious that other Members want to speak.
	Above all, that bond will make it much more difficult for enemies of the NHS to privatise our hospitals in the future.
	The only alternative to the proposals is to continue to invest more money in a structure run by local quangos and regulated by Whitehall. Giving local people a say in how the vast sums of money invested in their local services should be used is infinitely preferable.
	We should be radical. It is time that we matched our financial investment to our commitment to local democracy. My amendments are designed to do just that.

Richard Taylor: May I pay very sincere tribute to the right hon. Member for Holborn and St. Pancras (Mr. Dobson), who put the case in favour of his amendments so intensely clearly and has spoken up so strongly for all NHS staff, who do not want more interference?
	I shall be very brief because time is short, but I want to ask the Minister to clarify new clauses 36 and 37, which, to my amazement, were welcomed by the hon. Member for South Cambridgeshire (Mr. Lansley). As hon. Members will know I am extremely sensitive to mergers and closures, and those new clauses seem to provide draconian powers.
	The trusts interested in merger have to apply to the regulator, who at least, I am relieved to hear, will be accountable to the House, but new clause 36(3) says:
	"applicants may modify the application with the agreement of the regulator at any time before authorisation is given".
	The only mention of public consultation is in subsection (6):
	"If regulations require the applicants to consult prescribed persons about the application, the regulator"
	has to be satisfied that the applicants have complied. Which regulations may be relevant? Who are the prescribed persons who might be consulted? Are they just the management boards, the PCT patient forums, or the overview and scrutiny committees?
	Without its own patient forum, a foundation trust has no one to refer matters to overview and scrutiny committees and, in turn, no one to refer to the independent reconfiguration panel, unless I have got that wrong, and I should be delighted to hear from the Minister about that. Mergers will inevitably become more likely because of the European working time directive. If those new clauses are accepted, proper open consultation will be bypassed and people will be unable to stop closures because of the unlimited powers in the Bill. I fear that MPs may find their seats at risk.

Jon Owen Jones: I am pleased to be called to take part in the debate. Before I speak to amendment No. 60, which is in my name and the names of several of my hon. Friends, and a number of consequential amendments, I should like briefly to mention the right of Welsh MPs to speak in the debate, because my hon. Friend the Member for Wakefield (Mr. Hinchliffe) has indicated that other hon. Members and I should keep our noses out. He may not have noticed, but this is an England and Wales Bill—that will become clear when I speak to amendment No. 60, which is about foundation hospitals. Moreover, other parts of the Bill will be voted on by hon. Members from England in overwhelming numbers compared with the number of Members from Wales.
	I am not sure whether my hon. Friend is interested in those constitutional matters, but if he is, he will have noticed that on every England and Wales Bill in the past I have expressed my frustration that the time available to debate matters of extreme importance to Wales—primary legislation for Wales still rests with the House—is completely inadequate when we are also debating English matters, and I have suggested other routes so that we could have those debates. If we had other routes—if Welsh matters could be referred to a Grand Committee—I would be sympathetic to the argument that I should not participate in English affairs, but we do not, so I shall take part in the debate and I hope that my voice will be respected.
	The problem emerges from the first sentence in the Bill:
	"An NHS foundation trust is a public benefit corporation which is authorised under this Part to provide goods and services for the purposes of the health service in England."
	Hon. Members may not know it, but there is a great deal of cross-border movement for treatment in Welsh hospitals and English hospitals. Overwhelmingly, however, it is for the treatment of Welsh patients in English hospitals. Last year, 43,000 Welsh patients were treated in English hospitals. Some of those hospitals—particularly the one that treats the greatest number of Welsh patients, Countess of Chester hospital—are in the first wave of applications for foundation hospital status. Therefore, whether they have foundation status and whether it works properly is clearly an issue of importance to Welsh Members.

Chris Grayling: The hon. Gentleman is making extremely important points, and I hope that Ministers will listen. Is he aware that not only is there a cross-border flow of patients but, in the Welsh border areas, the hospital in Chester is the prime referral point for the majority of local GPs?

Jon Owen Jones: Yes. The issue is even more important for people from mid-Wales, where the only acute services available are on the other side of the border in Shrewsbury, Hereford and other hospitals. For many Welsh patients, therefore, English hospitals provide the only available acute services. How they are run is therefore extremely important.
	This Bill provides a legal duty and responsibility to treat English patients, but does not provide such a duty and responsibility to treat Welsh patients.

Ian Lucas: Has my hon. Friend, like me, received a letter from the Secretary of State for Health, which talks about the fact that health care should be provided equally to those who need it, free at the point of need? Does he agree that this Bill runs directly contrary to that principle, in that it provides preferential treatment to patients from England over and above those from Wales?

Jon Owen Jones: It certainly does. A pattern already exists, even prior to foundation hospitals being established, of Welsh patients finding it difficult to get access to the hospitals to which they would traditionally be sent from their catchment. An article in the Shropshire Star only yesterday stated:
	"A patient from Mid Wales has been refused a vital hip operation at a specialist orthopaedic hospital in Shropshire—because he is from Wales, a letter revealed . . . GP Dr Hywel Lloyd in Llanidloes received the . . . letter from a consultant orthopaedic surgeon at the Robert Jones and Agnes Hunt orthopaedic and district hospital in Gobowen."
	I could cite a number of examples of Welsh patients who are already having difficulty getting into English hospitals, even though those English hospitals do not have the additional power that they would have under foundation trust status to restrict the growing demand for their services from Welsh patients.
	I raised these matters at the Committee's first sitting and the answers given by the Minister, which were repeated by the Secretary of State for Wales, other Ministers and the Health Minister in the Welsh Assembly, were all to the effect that, to paraphrase, nothing in the Bill precluded or prevented Welsh patients from getting treatment. But that was never the question that I had asked. I asked why it was necessary to give Welsh and English patients a different legal status and to put Welsh patients in a disadvantageous position?
	The Government claim that they have amended the Bill to answer that point. They amended clause 14(1) in Committee, and at first glance it appears that the amendment meets the purpose. The original Bill said:
	"An authorisation must authorise the NHS foundation trust to provide goods and services for the purposes of the health service in England."
	The amended Bill now says:
	"An authorisation must authorise the NHS foundation trust to provide goods and services for purposes related to the provision of health care. "
	All well and good—it appears to answer the problem. However, the very next subsection says:
	"But the authorisation must secure that the principle purpose of the trust is the provision of goods and services for the purposes of the health service in England."
	How can one read that and not conclude that the Bill and the establishment of foundation hospitals will put Welsh patients in an inferior position?
	On Second Reading, I spoke in support of foundation hospitals, much to the annoyance of several of my hon. Friends, because I am in favour of reform in the health service. However, I must tell my hon. Friends on the Front Bench that the Government amendments tabled so far do not address the central point that I am making. I do not believe that they do not want to respond to the argument that I have made. Indeed, I am fairly convinced that privately they would like to agree to my amendments. They must stand up and make that point, because other hon. Members who support my proposals might think that if the Government cannot guarantee equal provision of services for people in Wales after the establishment of foundation hospitals, perhaps they should vote against establishing foundation hospitals. I do not hold that view because I support the principle of modernisation, but others might be less convinced.
	Several hon. Members, especially Liberal Democrat and Plaid Cymru Members, have made a point about devolution. They are reluctant to support my amendments because they would empower the Welsh Assembly to create foundation hospitals if it wished. Provisions giving the Assembly the choice to do something exist in many other Bills. I do not understand—I have received no explanation—why the Welsh Assembly would want to put Welsh patients at a disadvantage in the way in which I described simply in order to make a gesture by saying that it would not create foundation hospitals or take up the power to introduce them at a later date. That puts ideology in front of any practical benefit and protection for Welsh patients.

Hywel Williams: My party's standpoint is abundantly clear, as is that of the Scottish National party: we do not want foundation hospitals in Wales or Scotland and we are worried about cross-border effects. As was said earlier, the standpoint of the newly democratically elected Labour Government in the National Assembly for Wales is clear: they are against foundation hospitals.
	As the hon. Member for Cardiff, Central (Mr. Jones) said, clause 1 contains no reference to Wales, and he tabled amendment No. 60 to add such a reference. I take it from his remarks that he is in favour of establishing foundation hospitals throughout Wales, but that would be against the expressed wishes of my party and the Labour Government in Cardiff.
	The hon. Gentleman says that adding a reference to Wales in clause 1 would address the problems of cross-border treatment. We are certainly worried about those problems. We are concerned that three tiers of treatment will be available in England: treatment available in foundation hospitals, treatment available in other hospitals and treatment available for Welsh patients. As my hon. Friend the Member for Angus (Mr. Weir) said, there are potential consequences for the Barnett formula if hospitals in England lever in large amounts of private money. Will the Minister explain the consequences that that would have on the proportion of money available for Scotland and Wales?
	We accept the force of some of the arguments made by the hon. Member for Cardiff, Central about cross-border treatments, but we note the Government's assurances that the issues are properly addressed. Presumably, the logical conclusion for the hon. Gentleman is that if his amendments are not adopted, the Bill is flawed. In that case, is he prepared to vote against it? I understand from his remarks that he will support it even if it is flawed. Should he undertake to vote against the Bill, Plaid Cymru will be prepared to consider our position on his amendments.

Frank Field: I want to speak to amendment No. 321, the 25 associated amendments and new clause 34, which stand in my name and those of my hon. Friends.
	I begin where my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) began, by reminding the House that we are debating the one institution about which this country cares. He was right to say that, but it was only a partial truth. If we look back over the past 20 years, the respect that the NHS has commanded among our voters has declined. Just because most of our constituents willingly vote for extra taxes to pay for improvements in the NHS, we cannot sit back and think that that state of affairs will continue. If any of my hon. Friends doubt me, they need only look at that other popular institution of 20 years ago—the monarchy—which was more popular than the NHS. The fact that something commands public favour at one point in time does not of itself mean that that favour will continue.
	So the Government are right to take a twofold approach to NHS reform. The first approach is to commit record sums of taxpayers' money to improving services. The second is to consider institutional changes. I want to dwell on the size of the extra moneys that our constituents are willingly putting towards the NHS. We are approaching the mid-point of the Parliament. Even if our minds are not concentrated on the next election, our voters are increasingly thinking about it and the Government's record and performance. They will want improvement, over and above what they already expect, from the very large sums of money that they have willingly donated to improve the NHS. So my right hon. Friend was correct in saying that there are huge dangers in the Government playing around with the structure again at this time in the Parliament.
	I am glad that my hon. Friend the Member for Wakefield (Mr. Hinchliffe) is in the Chamber. No one was more favourable to the Bill's principles when we discussed it on Second Reading than I was. The direction that the Government wish to take—the ownership of the NHS—is right. I just question whether they have had sufficient time to listen enough or think enough about the structure that they will not only impose on many people, but roll out before the next election.
	Before hon. Members vote, I beg them to acquaint themselves with what is in the Bill on the register of electors. My right hon. Friend the Member for Holborn and St. Pancras was rather gentle with the Government. He talked about the additional cost each year for local authorities to keep their register of electors up to date—some £50 million. But we will not be asking foundation hospitals to use an existing body of electors. They have to start from scratch, so mega resources will go into trying to understand the legislation which we may or may not pass today, and building up that body of electors.
	The amendments and new clause in my name and that of my hon. Friends recognise that the Government are right to consider ways of changing from a producer-run to a consumer-run organisation. I do not accept that, as my right hon. Friend the Member for Holborn and St. Pancras said, there was a choice only between a producer-run body and a laptop. If that were the only choice, we would be with him. The Government are trying to feel a new way as they in effect denationalise the last nationalised industry in this country and the only nationalised industry about which people care.

Geoffrey Robinson: The amendments in my right hon. Friend's name, mine and that of several other hon. Members, all make the simple point that there is no use in planning for a roll-out of a major reorganisation that has not been pilot-tested first. The proposals embody some good and bold aspirations. Is not the answer to try them first, involve the new foundation hospitals together with primary care trusts on a limited geographical scale, and let them iron out the difficulties without another massive disruptive reorganisation?

Frank Field: My speech can now be even briefer. That was the next point that I wanted to make, and I agree with every word my hon. Friend said. Our large group of amendments is intended to say to the Government, "Well done. We think you are moving in the right direction, but we are worried about any possible disruption in the delivery of services between now and the next election." The amendments therefore propose the establishment of six foundation hospitals and six primary care trusts. New clause 34 lists who would carry out the evaluation and how they would report back to the Secretary of State and to us before there was any further roll-out.
	The simplest form of election would be to use the roll of electors who elect us. That would entail no extra administrative cost, and the people who act as returning officers in parliamentary elections would return the board members in the 12 pilots that the amendments propose. [Interruption.] My hon. Friend the Member for Pendle (Mr. Prentice) asks whether it would be a mutual organisation. No, of course not. I do not understand why the term "mutual" is being used. Most of my constituents think they own the health service. When one considers the difficulties that we place on our hospitals now, the idea of asking them to collect the quids or parts of quids and to deal with more administrative detail is a nightmare. My constituents are willingly paying to try and own the health services that they have. The Bill should be designed to give that effective form.
	The amendments set out the procedure for nominations. When we want to stand for Parliament, we have to get, say, 50 members of our local electorate to support us, and the same should apply to the election of board members. The returning officer would be the same as for parliamentary elections, as I said, and the Comptroller and Auditor General would carefully examine the key pilot experiments.
	We were told by the Minister of State, my right hon. Friend the Member for Barrow and Furness (Mr. Hutton), that we must not go into the Lobby with the Tories on any of the amendments today. Our fear is that if we rush headlong into reforms that are almost open-ended, we will deliver the NHS up to their reforms. What we want to do more than anything is to make sure that the extra resources being put through the NHS are shown to be effective, and that our constituents are allowed to experiment. The NHS has survived for 60 years because everybody in the country knew that it had a cast-iron guarantee, a security, a fall-back position. We could all say to our electorates, "Don't worry, the NHS would perform better if only it had more money," but the Government have bravely stripped away that defence. We cannot go into the next election saying, "The service would be better if only you were prepared to cough up more taxes," as our constituents are already doing that. I beg the Government to draw back a little in their proposed pace of reform, to concede that we need an array of pilots to deal with PCTs and foundation hospitals and to ensure that the vast majority of hospitals do what they are meant to do—deliver improved services—particularly before we have to meet our paymasters, the electorate, at the next election.

Patsy Calton: Time is short, so I shall be brief and confine my remarks to two areas about which I am especially concerned. They have been raised by other hon. Members and, to that extent, I shall seek to labour them, as I think they are important.
	Amendments Nos. 397 and 398 seek to reverse the Government amendments made in Committee that changed the sense of clause 15 and, in particular, the severity of the cap on private treatment. My hon. Friends and I regard it as imperative that the clause should be made clearer. Unfortunately, the Government have tabled yet another amendment, Government amendment No. 248, which makes it even less clear. It has become a dog's breakfast of a clause and, as a provision that deals with privatisation and the supposed cap on privatisation, it needs to be reconsidered to ensure that there is a cap on the amount of private treatment that can be given in a foundation hospital.
	The second area about which I am very concerned again relates to a Government proposal—Government new clause 36, relating to mergers. The hon. Member for Wyre Forest (Dr. Taylor) mentioned that issue, which goes beyond an attempt by the Government simply to ensure that there is not another hon. Member for Wyre Forest waiting out there. What is really important is that there should be transparency and honesty about the situation into which we are moving. If a foundation hospital can effectively become merged or closed and if its authorisation can be changed so that it can involve itself with more private treatment, and if all that can happen right up to the point at which authorisation is given, there will be no time whatever for public consultation. People will see their local hospital whipped away from them with no chance for them, their local politicians or anyone else to make any difference whatever.
	I ask the Government to reconsider new clause 36 and especially proposed subsection (3), which allows changes to be made to the application right up to the point at which authorisation is given. That is not right. The public need to know whether their hospital can be changed, closed, merged or privatised. There has been a reduction in transparency as the Bill has passed through the House.

John Hutton: I should like briefly to respond to some of the points made in the debate after I made my initial speech.
	I pay a very warm tribute to every hon. Member who has spoken in the past three hours or so. All debates about the national health service are high-quality debates. We in this place care about the national health service. I know that that is true of all my hon. Friends, but I ask them to recognise that it is true of Ministers too. We care about the national health service, which is why are making proposals to help improve and sustain the direction of travel that we have set in the NHS plan and beyond. Let us be clear about that.
	It is deeply depressing to see some of the Lib Dem amendments to which the hon. Member for Oxford, West and Abingdon (Dr. Harris) spoke tabled by someone occupying his space on the political spectrum. He wants to remove the provisions about direct elections to the boards of governors of NHS foundation trusts. I know that some of my hon. Friends would also like that to happen, but I have to say to him and to them that it would be entirely contrary to the spirit and intent of these proposals. A model of governance and representation that involves people being appointed to NHS trusts is no longer acceptable in the society in which we live. Let us have some democracy, but let us have some effective accountability as well.
	New clause 9 deals with patients forums. I fully understand the concerns expressed by the hon. Member for Oxford, West and Abingdon and others—for example, by my hon. Friend the Member for Bedford (Mr. Hall), who has played a distinguished role in this House in championing the cause of community health councils and the role of patients. However, the Government's arrangements for NHS foundation trusts extend beyond the current requirements for consultation and involvement. Primary care trust patients forums and the Commission for Patient and Public Involvement in Health will provide an additional means for independent patient involvement in the work of NHS foundation trusts. It is not the case that there will be no independent voice or opportunity for patients to be involved in the work of NHS foundation trusts. The patients forums established for primary care trusts will have that overview role. Nor is it the case, in relation to the comments of the hon. Member for Wyre Forest (Dr. Taylor), that there is no role for the overview and scrutiny committees of local authorities, whose role is protected in the Bill. I am afraid that those arguments have little or no substance.
	Let us also be clear about amendment No. 400, which would remove the cap on private charges altogether, replacing it with a system that would at best be a woolly attempt to give priority to the needs of NHS patients, but is clearly not a mechanism that is capable of being applied to any extent in the practical environment of the NHS. It is impractical, impossible to operate and riddled with contradictions—no change there as regards the Liberal Democrats.
	On new clause 36, the points made by the hon. Member for South Cambridgeshire (Mr. Lansley), which were picked up by the hon. Member for Cheadle (Mrs. Calton) and the hon. Member for Wyre Forest, suggest that there has been some misunderstanding of the Government's proposals. Under the new clause, an NHS foundation trust and another NHS foundation trust or an NHS trust may make a joint application to the regulator for authorisation as a new NHS foundation trust. In every other sense, we have simply mirrored the current provisions in the Bill on the principal application to become an NHS foundation trust. There is nothing different about the process at all.
	On the group of amendments, including new clause 60, that were moved by my hon. Friend the Member for Cardiff, Central (Mr. Jones), I am confident that nothing in the Bill changes or adversely affects the way in which Welsh patients are treated in NHS foundation trusts established in England. I say this to my hon. Friend, because I respect and value his counsel: my colleagues and I are prepared to have another look at the Bill to make absolutely sure that the assurances that we gave in Committee and on the Floor of the House are fully honoured. I hope that my hon. Friend will be satisfied with that.
	We are reaching the conclusion of this debate—which by common consent represents an important and seminal moment in this Parliament—as regards how we take forward improvements in the national health service. We have set out a clear prospectus today. This is not about competition, privatisation or two tiers: it is about taking forward traditional NHS values and applying them in the new world and new society in which we live. No one who is treated at an NHS foundation trust will be charged for that treatment. The standards that are set will be national: my right hon. Friend the Secretary of State will ensure that that is so. These are sensible reforms that will take forward a better basis and a more solid foundation on which we can build genuine and strong public support for public services. I urge my hon. Friends to support the Government in the Lobby.

Question put, That the amendment be made:—
	The House divided: Ayes 251, Noes 286.

Question accordingly negatived.

Liam Fox: On a point of order, Madam Deputy Speaker. Could you use your offices to get a quick breakdown of the vote, so that the House can see how many Scottish Members were used to force through legislation that does not apply to their constituencies?

Madam Deputy Speaker: Order. The normal procedures will apply to this vote as to any other vote in the Chamber.
	It being more than three and a quarter hours after the commencement of proceedings on the programme motion, Madam Deputy Speaker proceeded to put forthwith the Questions necessary for the disposal of the business to be concluded at that hour, pursuant to Order [this day].
	Amendment proposed: No. 96, in clause 2, page 1, line 12, after 'Foundation', insert 'and Community'.—[Mr. Lansley.]

Question put, That the amendment be made:—
	The House divided: Ayes 194, Noes 339.

Question accordingly negatived.

New Clause 9
	 — 
	Foundation Patients' Fora

'(1) The Secretary of State shall establish a body to be known as a Foundation Patients' Forum—
	(a) for each NHS Trust which has made an application under section 4(2);
	(b) for each person who has been incorporated as a public benefit corporation under section 5(5).
	(2) The members of the Foundation Patients' Forum are to be appointed by the Commission for Patient and Public Involvement in Health.
	(3) Once the Foundation Patients' Forum has been established, it may do anything (including the things mentioned in subsection (4) below) which appears to it to be necessary or desirable for the purpose of preparing for effective patient and public involvement in the NHS Trust or public benefit corporation once it becomes a Foundation Trust.
	(4) A Foundation Patients' Forum must—
	(a) monitor and review the range and operation of services provided by, or under arrangements made by, the trust for which it is established,
	(b) obtain the views of patients' and their carers about those matters and report on those views to the trust,
	(c) provide advice, and make reports and recommendations, about matters relating to the range and operation of those services to the trust,
	(d) make available to patients and their carers advice and information about those services,
	(e) in prescribed circumstances, perform any prescribed function of the trust with respect to the provision of a service affording assistance to patients and their families and carers,
	(f) carry out such other functions as may be prescribed.
	(5) In providing advice or making recommendations under subsection (4)(c), a Foundation Patients' Forum must have regard to the views of patients and their carers.
	(6) If, in the course of exercising its functions, a Foundation Patients' Forum becomes aware of any matter which in its view—
	(a) should be considered by a relevant overview and scrutiny committee, the Forum may refer that matter to the committee,
	(b) should be brought to the attention of the Commission for Patient and Public Involvement in Health, it may refer that matter to the Commission.
	(7) Subsection (6) does not prejudice the power of a Foundation Patients' Forum to make such other representations or referrals as it thinks fit, to such persons or bodies as it thinks fit about matters arising in the course of its exercising its functions.
	(8) An NHS Trust or public benefit corporation exercising its powers under sections 4(4)(b) or 5(7)(b) as the case may be shall be obliged to have regard to and take account of the reports and recommendations of the Foundation Patients' Forum.
	(9) The governors and non-executive directors of the Foundation Trust shall be obliged to respond in writing to the reports and recommendations of the Foundation Patients' Forum.
	(10) All the members, governors and directors of a Foundation Trust shall be obliged to have regard to and take account of the reports and recommendations of the Foundation Patients' Forum in exercising their functions within the Foundation Trust.
	(11) The terms in this section shall be construed in accordance with the provisions of section 15(8) and (9) of the National Health Service Reform and Health Care Professions Act 2002 (c.17).'.—[Joan Ryan.]
	Brought up, and read the First time.
	Motion made, and Question put, That the clause be read a Second time:—
	The House divided: Ayes 194, Noes 340.

Question accordingly negatived.

Simon Burns: On a point of order, Madam Deputy Speaker. As you will be aware, after the Division on amendment No. 164, the Government had their lowest majority in this Session—35. It might help the House to know that 40 Labour Scottish MPs voted with the Government to ensure that England did not have—[Interruption.]

Madam Deputy Speaker: Order. That is not a point of order for the Chair. I ruled on a similar matter earlier this afternoon.
	I understand that the Minister is prepared to move amendments Nos. 233, 354, 242 to 244 and 234 and new clause 24, so I shall include them in the groups that I am about to call him to move.

Clause 5
	 — 
	Other Applications

Amendment made: No. 245, in page 3, line 7, leave out 'registration' and insert 'incorporation'.—[Mr. Hutton.]

Clause 6
	 — 
	Authorisation of NHS Foundation Trusts

Amendment made: No. 233, in page 3, line 27, at end insert—
	'( ) taken as a whole the actual membership of the applicant's public constituency will be representative of those eligible for such membership,'.—[Mr. Hutton.]

Clause 10
	 — 
	Register of NHS Foundation Trusts

Amendment made: No. 355, in page 5, line 8, leave out from 'who' to end of line and insert
	'were first elected or appointed as'.—[Mr. Hutton.]

Clause 11
	 — 
	Power of Secretary of State to Give Financial Assistance

Amendment made: No. 356, in page 5, line 21, at end insert—
	'( ) The Secretary of State may guarantee the payment of any amount payable by an NHS foundation trust under an externally financed development agreement.
	"Externally financed development agreement" has the same meaning as in section 1 of the National Health Service (Private Finance) Act 1997 (c.56), reading references in subsections (3) and (5) of that section to the trust as references to the NHS foundation trust.'.—[Mr. Hutton.]

Clause 12
	 — 
	Prudential Borrowing Code

Amendment made: No. 246, in page 5, line 27, leave out 'organisations' and insert 'bodies.
	A body is non-profit making if it does not carry on activities for the purpose of making profits for distribution to its members or others.'.—[Mr. Hutton.]

Clause 15
	 — 
	Private Health Care

Amendments made: No. 247, in page 7, line 16, leave out
	'which was an NHS trust'.
	No. 248, in page 7, line 18, leave out 'the NHS foundation trust' and insert
	'an NHS foundation trust which was an NHS trust'.—[Mr. Hutton.]

Clause 33
	 — 
	Offence

Amendments made: No. 249, in page 12, line 31, leave out 'trust' and insert
	'relevant constituency and is not prevented from being a member of the board by paragraph 6A of Schedule 1'.
	No. 250, in page 12, line 32, leave out 'general'.
	No. 251, in page 12, line 34, leave out 'trust' and insert
	'relevant constituency and is not prevented from being a member of the board by paragraph 6A of Schedule 1'.—[Mr. Hutton.]

Clause 35
	 — 
	Interpretation of Part 1

Amendment made: No. 357, in page 13, line 11, at end insert 'or (Mergers)'.—[Mr. Hutton.]

New Clause 25
	 — 
	Audit

'Schedule (Audit of accounts of NHS foundation trusts) (which makes provision in relation to the audit of the accounts of NHS foundation trusts) has effect.'.—[Mr. Hutton.]
	Brought up, read the First and Second time, and added to the Bill.

New Clause 36
	 — 
	Mergers

'(1) An application may be made jointly by—
	(a) an NHS foundation trust, and
	(b) another NHS foundation trust or an NHS trust,
	to the regulator for authorisation of the dissolution of the trusts and the transfer of some or all of their property and liabilities to a new NHS foundation trust established under this section.
	(2) The application must—
	(a) be supported by the Secretary of State if one of the parties to it is an NHS trust,
	(b) specify the property and liabilities proposed to be transferred to the new NHS foundation trust,
	(c) describe the goods and services which it is proposed should be provided by the new trust, and
	(d) be accompanied by a copy of the proposed constitution of the new trust;
	and must give any further information which the regulator requires the applicants to give.
	(3) The applicants may modify the application with the agreement of the regulator at any time before authorisation is given under this section.
	(4) The regulator may—
	(a) issue a certificate incorporating the directors of the applicants as a public benefit corporation, and
	(b) give an authorisation under this section to the corporation to become an NHS foundation trust,
	if he is satisfied as to the following matters.
	(5) The matters are that—
	(a) the constitution of the new trust will be in accordance with Schedule 1 and will otherwise be appropriate,
	(b) taken as a whole the actual membership of the public constituency of the new trust will be representative of those eligible for such membership,
	(c) the new trust will be able to provide the goods and services which the authorisation is to require it to provide, and
	(d) any other requirements which he considers appropriate are met.
	(6) If regulations require the applicants to consult prescribed persons about the application, the regulator may not give an authorisation under this section unless he is satisfied that the applicants have complied with the regulations.
	(7) The certificate is conclusive evidence of incorporation; and the authorisation is conclusive evidence that the corporation is an NHS foundation trust.
	(8) On an authorisation being given under this section, the proposed constitution of the NHS foundation trust has effect, but the directors of the applicants may exercise the functions of the trust on its behalf until a board of directors is appointed in accordance with the constitution.'.—[Mr. Hutton.]
	Brought up, read the First and Second time, and added to the Bill.

New Clause 37
	 — 
	Section (Mergers): Supplementary

'(1) Where an authorisation is given under section (Mergers), the regulator is to specify the property and liabilities to be transferred to the new NHS foundation trust.
	(2) Where such an authorisation is given, the Secretary of State is to make an order—
	(a) dissolving the trusts in question, and
	(b) transferring, or providing for the transfer of, the property and liabilities specified by the regulator to the new NHS foundation trust.
	(3) The order may—
	(a) transfer, or provide for the transfer of, any of the remaining property or liabilities to the persons mentioned in section 25(3),
	(b) include provisions corresponding to those of Schedule 3.
	(4) Where an NHS foundation trust is dissolved under this section, the regulator must give notice of the dissolution to the registrar of companies.
	(5) Where one of the parties to an application under section (Mergers) is an NHS trust, the powers conferred on the Secretary of State by Part 4 of Schedule 2 to the 1990 Act are not exercisable in relation to the trust.
	(6) Subsections (3) and (5) of section 6 apply to an authorisation under section (Mergers) as they do in relation to an authorisation under that section.'.—[Mr. Hutton.]
	Brought up, read the First and Second time, and added to the Bill.

New Clause 24
	 — 
	Representative Membership

'An authorisation may require an NHS foundation trust to take steps to secure that (taken as a whole) the actual membership of its public constituency is representative of those eligible for such membership.'.—[Mr. Hutton.]
	Brought up, read the First and Second time, and added to the Bill.

New Schedule 2
	 — 
	'Audit of Accounts of NHS Foundation Trusts
	 — 
	General duty

1 In auditing the accounts of any NHS foundation trust an auditor must by examination of the accounts and otherwise satisfy himself—
	(a) that they are prepared in accordance with directions under paragraph 21 of Schedule 1,
	(b) that they comply with the requirements of all other provisions contained in, or having effect under, any enactment which are applicable to the accounts,
	(c) that proper practices have been observed in the compilation of the accounts, and
	(d) that the trust has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources.
	Right to documents and information
	2 (1) An auditor of an NHS foundation trust has a right of access at all reasonable times to every document relating to the trust which appears to him necessary for the purposes of his functions under Part 1.
	(2) The auditor may—
	(a) require a person holding or accountable for any such document to give him such information and explanation as he thinks necessary for the purposes of his functions under Part 1,
	(b) if he thinks it necessary, require the person to attend before him in person to give the information or explanation or to produce the document.
	(3) The auditor may also—
	(a) require any director or officer of the trust to give him such information or explanation as he thinks necessary for the purposes of his functions under Part 1,
	(b) if he thinks it necessary, require the director or officer to attend before him in person to give the information or explanation.
	(4) The trust must provide the auditor with every facility and all information which he may reasonably require for the purposes of his functions under Part 1.
	This paragraph does not affect the generality of subparagraphs (1) to (3).
	(5) A person who without reasonable excuse fails to comply with any requirement of an auditor of an NHS foundation trust under any of subparagraphs (1) to (3) is guilty of an offence.
	(6) A person guilty of an offence under subparagraph (5) is liable on summary conviction—
	(a) to a fine not exceeding level 3 on the standard scale, and
	(b) to an additional fine not exceeding £20 for each day on which the offence continues after conviction for the offence.
	(7) Any expenses incurred by an auditor of an NHS foundation trust in connection with proceedings for an offence under subparagraph (6) alleged to have been committed in relation to the audit of the accounts of the trust, so far as not recovered from any other source, are recoverable from the trust.
	Reports
	3 In auditing the accounts of an NHS foundation trust, the auditor must consider—
	(a) whether, in the public interest, he should make a report on any matter coming to his notice in the course of the audit, in order for it to be considered by the trust or brought to the attention of the public, and
	(b) whether the public interest requires any such matter to be made the subject of an immediate report rather than of a report to be made at the conclusion of the audit.
	4 (1) When an auditor of an NHS foundation trust has concluded his audit of the trust's accounts, he must enter on the accounts—
	(a) a certificate that he has completed the audit in accordance with Part 1, and
	(b) his opinion on the accounts.
	(2) But where the auditor makes a report to the trust under paragraph 3 at the conclusion of the audit, he may instead include the certificate and his opinion in that report.
	5 (1) Any report under paragraph 3 must be sent by the auditor to the trust and the regulator—
	(a) at once if it is an immediate report,
	(b) otherwise not later than 14 days after conclusion of the audit.
	(2) The trust must take the report into consideration as soon as practicable after receiving it.
	Referral to regulator
	6 If the auditor of an NHS foundation trust has reason to believe that the trust or a director or officer of the trust—
	(a) is about to make, or has made, a decision which involves or would involve the incurring of expenditure which is unlawful, or
	(b) is about to take, or has taken, a course of action which, if pursued to its conclusion, would be unlawful and likely to cause a loss or deficiency,
	he must refer the matter at once to the regulator.
	Audit of accounts of directors or officers
	7 (1) Where a director or officer of an NHS foundation trust receives money or other property—
	(a) on behalf of the trust, or
	(b) for which he ought to account to the trust,
	the accounts of the director or officer are to be audited by the auditor of the accounts of the trust.
	(2) The accounts of the director or officer are to be made up to 31st March.
	(3) Paragraph 20(4) of Schedule 1 and paragraphs 1 to 5 of this Schedule apply with the necessary modifications to the audit under this paragraph.
	Restriction on disclosure of information
	8 (1) No information relating to an NHS foundation trust or other person and obtained by an auditor (or by a person acting on the auditor's behalf) under Part 1 or in the course of an audit under that Part is to be disclosed except—
	(a) with the consent of the person to whom the information relates,
	(b) for the purposes of any functions of an auditor of an NHS foundation trust,
	(c) for the purposes of the functions of the regulator,
	(d) for the purposes of the functions of the Comptroller and Auditor General under Part 1,
	(e) for the purposes of the functions of the Commission for Healthcare Audit and Inspection under Part 2,
	(f) for the purposes of any criminal proceedings.
	(2) A person who discloses information in contravention of subparagraph (1) is guilty of an offence.
	(3) A person guilty of an offence under subparagraph (2) is liable—
	(a) on summary conviction, to imprisonment for a term not exceeding six months or to a fine not exceeding the statutory maximum (or to both),
	(b) on conviction on indictment, to imprisonment for a term not exceeding two years or to a fine (or to both).'.—[Mr. Hutton.]
	Brought up, read the First and Second time, and added to the Bill.

Schedule 1
	 — 
	Constitution of Public Benefit Corporations

Amendments made: No. 253, in page 99, line 16, at end insert—
	'( ) The area specified under subparagraph (1)(a) must be an electoral area for the purposes of local government elections in England or an area consisting of two or more such electoral areas.'.
	No. 254, in page 99, line 20, leave out subparagraphs (3) and (4) and insert—
	'(3) The constitution may also provide for the staff constituency to comprise individuals who exercise functions for the purposes of the corporation otherwise than under a contract of employment with the corporation.
	(4) A person may become or continue as a member of the staff constituency only if—
	(a) he is employed by the corporation under a contract of employment which has no fixed term or has a fixed term of at least 12 months, or
	(b) he has been continuously employed by the corporation for at least 12 months or, where subparagraph (3) applies, he has continuously exercised functions for the purposes of the corporation for such a period.
	(5) A person eligible for membership of the staff constituency may not become or continue as a member of the public constituency.
	(6) Chapter 1 of Part 14 of the Employment Rights Act 1996 (c.18) applies for the purpose of determining whether an individual has been continuously employed by the corporation, or has continuously exercised functions for the purposes of the corporation, as it applies for the purposes of that Act.'.
	No. 255, in page 99, line 26, leave out 'be' and insert 'become'.
	No. 256, in page 99, line 28, leave out subparagraph (2).
	No. 257, in page 99, line 36, leave out 'be' and insert 'become or continue as'.
	No. 258, in page 100, line 3, leave out subparagraph (2) and insert—
	'(2) Only members of the corporation and persons appointed under the following provisions may become or continue as members of the board.'.
	No. 259, in page 100, line 11, leave out 'postal' and insert 'secret'.
	No. 260, in page 100, line 11, at end insert—
	'6A (1) The following may not become or continue as members of the board of governors—
	(a) a person who has been adjudged bankrupt or whose estate has been sequestrated and (in either case) has not been discharged,
	(b) a person who has made a composition or arrangement with, or granted a trust deed for, his creditors and has not been discharged in respect of it,
	(c) a person who within the preceding five years has been convicted in the British Islands of any offence if a sentence of imprisonment (whether suspended or not) for a period of not less than three months (without the option of a fine) was imposed on him.
	(2) The constitution may make further provision as to the circumstances in which a person may not become or continue as a member of the board.'.
	No. 354, in page 100, line 16, at end insert—
	'( ) At least one member of the board is to be appointed by one or more qualifying local authorities.
	A qualifying local authority is a local authority for an area which includes the whole or part of the area specified under paragraph 3(1)(a).'.
	No. 261, in page 100, line 19, at end insert—
	'(5) An organisation specified in the constitution as a partnership organisation may appoint a member of the board.'.
	No. 262, in page 101, line 7, leave out subparagraph (2) and insert—
	'(2) A person may not be appointed as an executive director if he is within paragraph 6A(1).
	(3) A person may be appointed as a non-executive director only if—
	(a) he is a member of the public constituency, or
	(b) where any of the corporation's hospitals includes a medical or dental school provided by a university, he exercises functions for the purposes of that university,
	and he is not within paragraph 6A(1).'.
	No. 263, in page 101, line 9, at end insert 'chairman and the other'.
	No. 242, in page 101, line 28, at end insert—
	'(d) a register of interests of the directors.'.
	No. 243, in page 101, line 30, at end insert—
	'17A The constitution is to make provision for dealing with conflicts of interest of the directors.'.
	No. 244, in page 101, line 36, leave out paragraph (c) and insert—
	'(c) the registers mentioned in paragraph 17,'.
	No. 234, in page 103, line 7, leave out 'any' and insert—
	'(a) information on any steps taken by the corporation to secure that (taken as a whole) the actual membership of its public constituency is representative of those eligible for such membership,
	(b) any other'.—[Mr. Hutton.]

Schedule 2
	 — 
	Independent Regulator of NHS Foundation Trusts

Amendments made: No. 264, in page 104, line 23, leave out from 'is' to first 'a' in line 24.
	No. 265, in page 104, line 29, leave out
	'as a member of staff'
	and insert
	'in the employment by reference to which he was a participant'.—[Mr. Hutton.]

Schedule 4
	 — 
	Amendments Relating to NHS Foundation Trusts

Amendments made: No. 266, in page 110, line 29, after 'or', insert 'otherwise'.
	No. 358, in page 114, line 8, at end insert—
	'(c) in paragraph 32, at the end there is inserted "or section (Section (Mergers): supplementary) of the Health and Social Care (Community Health and Standards) Act 2003".'.
	No. 267, in page 116, line 28, at end insert—
	'The Antiterrorism, Crime and Security Act 2001 (c.24)
	118A The Antiterrorism, Crime and Security Act 2001 is amended as follows.
	118B In Schedule 4 (extension of existing disclosure powers), at the end of Part 1 there is inserted—
	"53A Paragraph 8(1) of Schedule (Audit of accounts of NHS foundation trusts) to the Health and Social Care (Community Health and Standards) Act 2003.".'.—[Mr. Hutton.]

Patrick Cormack: On a point of order, Madam Deputy Speaker. Can you confirm that that extraordinary list of amendments, which was not read out by Mr. Deputy Speaker for understandable reasons, will be printed in Hansard, so that people know how many amendments were tabled for this short period?
	More important, Madam Deputy Speaker, would you ask Mr. Speaker whether he will refer the whole question of programming to the Procedure Committee so that, in future, the time taken for votes is not counted in the programme motion? As it is, we have exactly half an hour left to debate what we were given an hour and a half to debate. I hope that you agree, Madam Deputy Speaker—[Interruption]—and I hope that those who are protesting would agree that this adds to the insult to Parliament.

Hon. Members: Hear, hear.

Madam Deputy Speaker: Order. In response to the first part of the point of order, I can assure the hon. Member for South Staffordshire (Sir Patrick Cormack) that all those amendments and new clauses will be included in Hansard tomorrow.
	On the second point, as the present occupant of the Chair, I am very mindful both that time is proceeding and of the time that is left for the debate. I shall certainly make sure that Mr. Speaker is aware of that. The Procedure Committee or the Modernisation Committee may already be considering the point raised by the hon. Gentleman.

New Clause 30
	 — 
	Complaints About Health Care

'(1) The Secretary of State may by regulations make provision about the handling and consideration of complaints made under the regulations about—
	(a) the exercise of any of the functions of an English NHS body or a cross-border SHA;
	(b) the provision of health care by or for such a body;
	(c) the provision of services by such a body or any other person in pursuance of arrangements made by the body under section 31 of the Health Act 1999 (c.8) in relation to the exercise of the health-related functions of a local authority.
	(2) The Assembly may by regulations make provision about the handling and consideration of complaints made under the regulations about—
	(a) the exercise of any of the functions of a Welsh NHS body;
	(b) the provision of health care by or for a Welsh NHS body;
	(c) the provision of services by a Welsh NHS body or any other person in pursuance of arrangements made by the body under section 31 of the Health Act 1999 (c.8) in relation to the exercise of the health-related functions of a local authority.
	(3) Regulations under this section may provide for a complaint to be considered by one or more of the following—
	(a) an NHS body;
	(b) the CHAI;
	(c) an independent lay person;
	(d) an independent panel established under the regulations;
	(e) any other person or body.
	(4) Regulations under this section may make provision for a complaint or any matter raised by a complaint—
	(a) to be referred to a Health Service Commissioner for him to consider whether to investigate the complaint or matter under the Health Service Commissioners Act 1993 (c.46) (and to be treated by him as a complaint duly referred to him under section 10 of that Act);
	(b) to be referred to any other person or body for him or it to consider whether to take any action otherwise than under the regulations.'.—[Dr. Ladyman.]
	Brought up, and read the First time.

Stephen Ladyman: I beg to move, That the clause be read a Second time.

Madam Deputy Speaker: With this it will be convenient to discuss the following:
	Government new clause 31—Complaints about social services.
	Government new clause 32—Complaints regulations: supplementary.
	Government new clause 33—Representations relating to special guardianship support services.
	Government amendment No. 301.
	Amendment No. 40, in clause 107, page 44, line 7, leave out subsection (1) and insert—
	'(1) Complaints under this Act may be made by an individual or a body of persons, whether incorporated or not.
	(1A) A complaint may be submitted in respect of—
	(a) the exercise by an NHS body of any of its functions,
	(b) the provision by any person of health care for which the body is responsible.
	(c) the provision of services by the body or any other person in pursuance of arrangements made by the body under section 31 of the Health Act 1999 in relation to the exercise of the health-related functions of a local authority.
	(1B) A complaint may be initiated by—
	(a) the person aggrieved,
	(b) his personal representative,
	(c) a member of his family,
	(d) an independent advocate, or
	(e) some body or individual suitable to represent him.'.
	Amendment No. 41, in page 44, line 7, leave out 'may' and insert 'shall'.
	Amendment No. 42, in page 44, line 17, leave out 'may in particular make' and insert 'shall make further'.
	Amendment No. 43, in page 44, line 17, leave out 'may' and insert 'shall'.
	Amendment No. 44, in page 44, line 18, leave out paragraph (a).
	Amendment No. 45, in page 44, line 20, at end insert
	', including timescales for completion of each stage'.
	Amendment No. 46, in page 44, line 26, at end insert—
	'(h) for a specific complaint and redress procedure for challenging the refusal of NHS-funded continuing care'.
	Amendment No. 47, in page 44, line 27, leave out subsection (3).
	Amendment No. 48, in page 44, line 29, leave out
	'and within the prescribed period'.
	Amendment No. 49, in page 44, line 37, leave out paragraph (d).
	Amendment No. 50, in page 44, line 37, at end insert—
	'(e) primary care practices providing NHS services under contract, and other private providers treating patients under contract with an NHS body'.
	Amendment No. 51, in page 44, line 37, at end insert—
	'(4A) The provision that may be made under subsection (2)(f) includes the provision for a report about a complaint to recommend the making of an ex-gratia payment in respect of injuries sustained, loss of earnings or expenses incurred as a consequence of the incident or incidents complained about.'.
	Amendment No. 52, in page 45, line 4, leave out 'may' and insert 'shall'.
	Amendment No. 53, in page 45, line 6, at end insert—
	'(6A) Provision under subsection (2)(g) will include provision for a complaint to be referred to either the CHAI or the Health Service Commissioner if the complaints procedure has not been completed at the relevant stage within a reasonable timeframe.'.
	Amendment No. 54, in page 45, line 16, at end insert—
	'(8A) Regulations under this section shall include provisions for the right to an oral hearing with the investigating officers of the relevant body where appropriate.'.
	Amendment No. 26, in page 45, line 19, at end insert—
	'(10) No regulations may be made under this section unless a draft of the regulations has been laid before Parliament and approved by a resolution of each House.'.
	Government amendments Nos. 302 and 303.
	Amendment No. 55, in clause 109, page 46, line 43, at end insert—
	'( ) for circumstances in which a complaint may be considered, including—
	(i) the breach of any duty under Part IV of the Care Standards Act 2000, and
	(ii) the breach of any duty to provide services under Part III of the Health Service and Community Care Act 1990 (c.19).'.
	Amendment No. 27, in page 47, line 41, at end insert—
	'(10) No regulations may be made under this section unless a draft of the regulations has been laid before Parliament and approved by a resolution of each House.'.
	Government amendments Nos. 304 to 312 and 316 to 318.
	Amendment No. 28, in clause 181, page 95, line 35, after 'from', insert
	'regulations under section 107 or 109 or'.
	Government amendments Nos. 313 to 315 and 319.

Stephen Ladyman: We now come to the part of the Bill that everyone is really interested in. I wish to speak to Government new clauses 30, 31 and 32, and I will comment on the other new clauses and amendments in this group. I shall try to be as brief as possible so that other hon. Members can speak.
	Government new clauses 30 to 32 will replace clauses 107 to 110 on health and social services complaints in England and Wales, so removing a large amount of repetition of common provisions by combining those clauses into a supplementary clause. I apologise to the House for tabling replacement clauses on Report, but I hope that hon. Members will agree that that approach is preferable to tabling a large number of drafting amendments. I took that decision because I thought it preferable to introduce the new clauses on Report, rather than waiting for the Bill to reach the Lords. Time constraints did not allow a debate on the complaints clauses in Committee, so time has not been wasted debating those clauses that we now propose to replace.

Patrick Cormack: rose—

Stephen Ladyman: New clause 30 will allow regulations to be made setting out the procedure to be followed when considering complaints received by an NHS body in England and Wales about the exercise of its functions.

Hon. Members: Give way.

Stephen Ladyman: I shall give way, but then I want to make progress.

Patrick Cormack: I am grateful to the hon. Gentleman for giving way, but that is the very point that I am making. Does he truly and sincerely think that the House now has adequate time to debate what was not debated in Committee? Can he give a straight answer to that question?

Stephen Ladyman: The House has voted on the programme motion; the House clearly believes that it has adequate time.

Lynne Jones: Will my hon. Friend give way?

Stephen Ladyman: Yes, but this is the last time.

Lynne Jones: My hon. Friend says that he took that decision. May I ask whether he personally took the decision?

Stephen Ladyman: Of course not; I made a recommendation to the Secretary of State for Health and he made the decision.
	New clause 31 will allow regulations to be made setting out the procedure to be followed when considering complaints received by a local authority in England or Wales about the discharge of its social services functions.
	New clause 30(1) and (2), and new clause 31(1) and (3) will allow regulations to be made setting out the procedure for handling and considering complaints where a complaint is made about the exercise of an NHS body's functions or health care provided by or for such a body, or where a complaint is made to a local authority in England or Wales respectively. The regulations made under those clauses can specify in what circumstances a complaint will trigger the formal complaints procedures, as prescribed in the regulations.
	NHS bodies or local authorities may often be able to address concerns expressed or issues raised by service users, or their relatives or carers, without the formal complaints procedures being used. We want people to have access to the formal procedures when they want them, but we do not want to force people to undertake the whole process if they prefer a less formal approach.
	There are also a number of drafting amendments to provide for consistency and clarity of wording between the various complaints clauses. The new clauses make it clear that, if the Commission for Healthcare Audit and Inspection, the Commission for Social Care Inspection or, in Wales, the independent panel, refer a complaint to the health service commissioner or local government ombudsman, the commissioner or ombudsman will have discretion about the action that they might take in response and are not obliged to investigate every case. A further amendment aims to clarify the intention of clause 109(8) and reconcile it with the language used in the Children Act 1989 in respect of representations and complaints.
	The purpose of new clause 32 is to combine all common provisions that exist for the handling and consideration of health care and social services complaints for both England and Wales into one new clause. It has been drafted to clarify the policy intentions and any procedural differences between health care and social services in both England and Wales. Subsection (2) combines common provisions in clauses 107 to 110, and specifies the persons who may make a complaint, the complaints which may or may not be made, complaints which need not be considered, the period within which complaints must be made and the procedures for making and considering a complaint. It also allows for regulations to be made about which complaints may be heard, about the making of a report about the complaint and the action to be taken once a complaint is made.
	Subsection (3) is intended to provide for the body considering a complaint to be able to recover its costs from the body complained about if it wishes, depending on precisely how it decides to execute the functions being bestowed on it to investigate and resolve complaints. The new wording of subsection (3) is intended to clarify the position on who makes the payment and to whom the payment is made. It also replaces the word "fee", which implies a service rendered, with "payment", which more accurately reflects the position that the payment is to cover costs incurred in considering the complaint.
	The new clause also contains a consequential amendment to ensure consistency of wording in the Bill in relation to disclosure of information to third parties. As currently drafted, clauses 107(9), 108(9), 109(9) and 110(10) may be interpreted as applying to unspecified obligations of confidence, which would mean that they would override obligations arising under statute as well as common law. The clause does not override the specific protections from disclosure for individuals set out in the Data Protection Act 1998: information relating to individuals must not be disclosed without the consent of that individual unless it is necessary to do so for any of the reasons specified in the Act. Personal data will still need to be processed lawfully in accordance with the provisions of the Act, and it is not the intention that information relating to individuals will be disclosed without their consent unless the Data Protection Act provides that that may be done.
	Subsection (5) allows for regulations to provide for cross-cutting complaints, not all of which could be considered under one set of regulations. The intention is that when a complaint would fall to be considered under two different schemes, the regulations enable the complaint to be considered in parallel. A single complaint of this kind would trigger action under both sets of regulations, each working in parallel, so that for the complainant, it appears as one system.
	New clause 33 tidies up the legislation by revoking section 14G of the Children Act 1989 and inserting a new subsection into section 26 of that Act, which brings complaints about such special guardianship support services functions as may be specified in regulations within the ambit of the complaints procedure established under section 26. Section 14G was inserted into the Children Act 1989 by section 115 of the Adoption and Children Act 2002. The policy intention was always that complaints about special guardianship support services in relation to children should be considered under the Children Act complaints procedure.
	The Bill preserves a separate procedure for the consideration of complaints that are capable of being considered under section 24D or section 26 of the Children Act, and we therefore need to make it possible for some complaints about special guardianship support services to be considered under this procedure. We also want such complaints to come within the provisions for further consideration by the Commission for Social Care Inspection under clause 111. The most effective way of achieving that is to revoke section 14G of the Children Act, and to extend the coverage of section 26 to include those complaints, which is what the new clause does.
	Work is still to be done on defining the precise nature of special guardianship support services. During the passage of the Adoption and Children Bill, the Government promised that we would consult stakeholders extensively on the development of support services for special guardianship. The definitive range of support services will be finalised only after a public consultation. We will then wish to consider which complaints about which services will be considered under the Children Act procedure because we envisage that only complaints relating to the provision of services that are directly for the benefit of a child should be considered under that procedure. That explains why we need to be able to specify the functions that will be considered under the Children Act procedure in regulations. That is consistent with the system for complaints from people provided by the adoption service. There should be parity for special guardianship.
	Amendments Nos. 301 to 304 are necessary because they remove clauses 107 to 110—the current complaint clauses—so that they may be replaced by new clauses 30 to 32.
	I shall briefly touch on the other amendments in the group and explain why the House would be well advised to resist them. Clause 107(1) sets out in general terms what a complaint may be about. However, amendment No. 40 would broaden that provision by detailing who may make a complaint. The amendment is unnecessary and would put too great a level of detail in the Bill.
	Amendments Nos. 41 to 43 and 52 should also be resisted. I understand the effect that they would have but they are unnecessary. I assure the House that we have every intention of using the regulation-making power provided by clause 107 and the other clauses relating to complaints procedures.
	Amendments Nos. 44 and 47 should be resisted. They would remove the ability to make regulations to set parameters for the complaints procedure in terms of what, who, how and when, which is not sensible. It is right that the procedure has always allowed patients, or a person acting on their behalf, the right to complain if they are not happy with the service or treatment received from the NHS. Of course, other people who use or are in NHS facilities, such as visitors and contractors, should be able to raise concerns, but not necessarily under the NHS complaints procedure.
	Amendment No. 45 is unnecessary because the existing wording of the Bill is sufficient to provide for the time scales and deadlines that it would create. Amendment No. 46 should be resisted because the powers in the Bill and Government new clauses 30 and 32 are sufficient to ensure that the complaints procedure will apply to all manner of services and treatment provided, subject to any exceptions thought necessary. The amendment would add too much detail to the Bill.
	I understand the motives behind amendment No. 48. However, it is important for there to be a time limit so that people are encouraged to make complaints as quickly as possible while events are fresh in the memories of those involved. I appreciate that there might be extenuating circumstances if people suffer trauma or distress, so it is right and proper that there should be discretion to waive the time limit, if appropriate. Sensitivity must be used and I promise that we will consider the matter carefully when drawing up the regulations.
	Hon. Members should resist amendment No. 49. I do not understand the point of accepting an amendment that would restrict the range of options available for the successful resolution of a complaint. Amendment No. 50 should be resisted and although I understand the thinking behind it, the Bill adequately covers the proposed provision.
	Amendment No. 51 is unnecessary. NHS bodies are already allowed to make ex-gratia payments if a claimant has suffered a financial loss, such as expenses incurred as a result of a complaint. NHS organisations will continue to have such flexibility after we have made regulations under the Bill. Again, I understand the thinking behind amendment No. 53, but it would add too much detail to the Bill.
	The provisions suggested by amendment No. 54 are already covered by the Bill. Amendments Nos. 26 and 27 are undesirable because they would provide that regulations would be subject to affirmative resolution. Opposition amendment No. 28 deals with things that are usually addressed under the negative procedure. Amendment No. 55 should be resisted because clause 111 provides for an effective, speedy and fair process. The clause, and other provisions, also cover the measures proposed in the amendment. Finally, I recommend amendments Nos. 305 to 319. They are technical, clean up the wording and are consequential on other amendments.

Simon Burns: I assure the House that I shall not speak for long. As my hon. Friend the Member for South Staffordshire (Sir Patrick Cormack) rightly explained, the vagaries of the Government's programme motion mean that we have only 45 minutes to discuss a key part of the Bill, bearing it in mind that we were unable to debate 50 clauses in Committee because of the programme motion Upstairs. In addition, the Government have tabled four new clauses and 18 amendments, which have eaten into that time.
	I shall concentrate on amendments Nos. 26 to 28. It is clear from the Government new clauses that they will once again rely on regulations to flesh out the fine detail of how the Bill will operate in practice. That has happened with many of their measures and reflects their approach to the crucial subject of social care. We all know that negative procedures are about as relevant as an ex-MP. It is difficult to find opportunities to hold the Government to account and debate such measures in detail. We can pray against them, but that is not the same as insisting on affirmative resolution, which triggers an automatic debate before measures become law.
	Imitation is apparently the greatest form of flattery. My amendments try to imitate what the Labour Opposition did for 18 years when they sought to hold the Government of the day to greater account by insisting on secondary legislation that was subject to affirmative resolution. On reflection, we were probably wrong to use the negative rather than the affirmative procedure. However, having researched primary health legislation during the Thatcher-Major years, it is clear that we were prepared to make far more of the secondary legislation in our primary legislation subject to affirmative resolution rather than to negative resolution.
	The Minister is new, so my speech will be novel to him. It would not be novel to the Minister of State, the right hon. Member for Barrow and Furness (Mr. Hutton), and I must apologise to my hon. Friends who heard it numerous times when we discussed three primary health Bills in Committee. I think that it gains in stature with the telling, and I am pleased that the Minister is hearing it for the first time. He kindly and uniquely for a Minister in this Government assured us in a Standing Committee last week that he was the sort of thinking man—again, unusual for this Government—who was prepared to consider the Opposition's valid points. To the utter horror of his Whip, he said that if the Opposition had a good point, he would be prepared to change the legislation.
	I challenge the new Minister—a so-called thinking Minister, if that is not a contradiction in terms for this Government—to give an instant response to my concerns. I know that that is unlikely because he responded to my amendments before I had a chance to explain what they would do. However, there is time in another place for him to show how reflective—the word he used last week—and intelligent he is. He should realise that it is right that we hold the Government more to account and save them from themselves if they make mistakes in secondary legislation. He can table amendments in another place to include affirmative resolution. Much of the detail is important because it fleshes out the Bill.

Paul Burstow: I shall speak briefly to the principles behind the amendments, without elaborating on the detail, as the Minister kindly outlined the purpose of our amendments for us. I entirely subscribe to the view expressed by the hon. Member for West Chelmsford (Mr. Burns) about the need for the affirmative procedure in respect of this important subject, not least because the House will not have the opportunity adequately to scrutinise this part of the Bill. We did not debate it at all in Committee and we have a minuscule amount of time in which to try to do it justice today, yet there is no doubt that independent complaints procedures that are transparent and easily accessible, and which ensure a good flow of communication between the body that is the subject of the complaint and the complainant, are an important part of improving patients' experience and the quality of care that they receive.
	I shall raise a couple of points with the Minister. Can he say whether, in the regulations that the Government plan to introduce, they will stipulate training requirements for NHS and social services staff to make them aware of the complaints procedures that they have to operate, and to enable them to provide the informality that he mentioned, before a more formal complaints process begins?
	Amendments No. 41 to 43 deal with whether there should be a discretionary power to make regulations, as implied by the use of the word "may", or an explicit mandatory duty for the Secretary of State to introduce regulations to establish clear complaints procedures. The Liberal Democrat view is that that should not be at the discretion of Secretaries of State, but a requirement. There should be a complaints procedure. That should not need the assurance of a Minister that powers will be exercised. It should be for the House to write into the Bill that we expect Ministers to exercise those powers, consult and introduce regulations.
	The Minister says that our amendments to deal with time scales are a level of detail too far. That argument is regularly deployed by Ministers to rebut any amendments to regulation-making powers, but can he explain to me and perhaps to those outside, why it is appropriate to impose a time limit on complainants for making a complaint, but reasonable for the Government not to set time scales for each stage of the complaints process? Amendments Nos. 45 and 53 try to concentrate the minds of NHS bodies and social services departments to ensure that they do not just hit their target by responding by letter within 20 days and say that they have dealt with the complaint, but go about dealing with it meaningfully.
	That brings me to a couple of questions that I raised in Committee but which, because of the vagaries of the process, never received a reply from the Minister with responsibility for these matters at the time. Where a complaint has been made—for example, where a poor assessment is made in an acute trust, which leads to an inappropriate discharge to intermediate care provided by a primary care trust, which itself fails to realise that the discharge is inappropriate and fails to readmit the person to the acute trust—is it for the complainant to navigate their way round the system, complain to the PCT and the acute trust, and work out where the complaint should be directed? Should it not be for the bodies that are the subject of the complaint to work together co-operatively so that they provide a seamless approach to dealing with complaints? Should there not be regulations to that effect?
	The same applies in respect of health and social care. Increasingly, where services are integrated and provided seamlessly, it becomes less clear whether complaints should be addressed to social services or health departments. The regulations need to clarify that. I hope the Minister can give us some reassurance on those matters. We shall return to some of the amendments at later stages of the Bill. Hopefully, in the other place, there will be sufficient time to ensure that we get adequate responses to our concerns.

Patrick Cormack: There may indeed be some time in the other place, but that is no answer to those of us who are concerned about this place. While I welcome the Minister to his portfolio—he comes to it with a reputation as a thoughtful and hard-working man and I wish him every success—he must be ashamed of himself for what he had to do today. He had to gabble through, reading every last word, not only on the details of what the Government are proposing, but prepared replies on all the amendments that had not yet been spoken to by my hon. Friend the Member for West Chelmsford (Mr. Burns) or the hon. Member for Sutton and Cheam (Mr. Burstow). That is not only an insult to Parliament, but an insult through Parliament to every constituent who sent us here.
	I do not blame the Minister individually. He is working to orders, as he made plain in replying to an intervention. He cannot yet make the decisions, but no self-respecting parliamentarian, whatever his or her views and whatever party he or she belongs to, could be anything but ashamed that this is how Parliament deals with a Bill of extreme importance.
	I do not make these remarks merely as somebody who is opposing the Government. Indeed, I did not oppose them in the first Division. Neither do I speak having never opposed my own Government. Although the guillotine was generous in comparison with today's, I remember throwing down my papers and refusing to vote on Third Reading of the NHS reform Bill introduced by my right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke), as I felt that Parliament was being badly treated. However, if Parliament was being badly treated then, it is being totally abused now, and Ministers should be thoroughly ashamed of themselves.
	When we look at the selection list, we see that there are four new clauses and about 40 amendments relating to the crucial subject of complaints procedures, which affect so many of our constituents. There are issues such as guardianship, but the Minister gabbled through that bit at such a rate of knots that, quite honestly, I could not understand what he was saying and I shall have to read it in Hansard tomorrow. Of course, I shall do so, but that is not good enough. When we have dealt with the current group of amendments, and although we have to finish at 5.50 pm, we must still deal with standards for health and social care, provision of health and social care in cross-border areas and registration and regulation of social care services and other services for children—and this Government are supposed to be child-friendly.
	Madam Deputy Speaker, this is really not good enough. I was grateful to you for the thoughtful and considerate manner in which you replied to my point of order, but unless the voting time can be taken out of such programme motions, we may as well all pack up and go home, and show people out there how little care, concern, consideration and deliberation we give to issues that affect their daily lives.
	I sit down in total disgust at the way in which this matter has been handled.

Stephen Ladyman: I shall be very brief in answering the points that have been raised. I hear what the hon. Member for South Staffordshire (Sir Patrick Cormack) is saying and I shall certainly reflect on his thoughts and his admonition to me.
	The hon. Member for West Chelmsford (Mr. Burns) pointed out that a prayer against could be used to secure the negative procedure, which puts in the hands of the House the decision on whether these matters are debated. He also noted my assurance that I would reflect on points made by the Opposition and be prepared to change the legislation if they made a good point. He will recollect that I said that I thought it highly unlikely that they would come up with any such points that we had not thought of. None the less, I confirm that I shall reflect on everything that the Opposition say to me.
	I can assure the hon. Member for Sutton and Cheam (Mr. Burstow) that we will consider the possibility of training in the regulations. We are determined that the two organisations will review complaints and carry out reviews in a seamless fashion. Indeed, the legislation requires them to work closely together, so I hope that people who complain will get such an assurance. We will also consider time limits for each stage of the procedure during consultation on the regulations.
	Question put and agreed to.
	Clause read a Second time, and added to the Bill.

New Clause 31
	 — 
	Complaints About Social Services

'(1) The Secretary of State may by regulations make provision about the handling and consideration of complaints made under the regulations about—
	(a) the discharge by a local authority in England of any of its social services functions;
	(b) the provision of services by another person pursuant to arrangements made by such an authority in the discharge of those functions;
	(c) the provision of services by such an authority or any other person in pursuance of arrangements made by the authority under section 31 of the Health Act 1999 (c.8) in relation to the functions of an NHS body (within the meaning of that section).
	(2) Regulations under subsection (1) may provide for a complaint to be considered by one or more of the following—
	(a) the local authority in respect of whose functions the complaint is made;
	(b) the CSCI;
	(c) an independent panel established under the regulations;
	(d) any other person or body.
	(3) The Assembly may by regulations make provision about the handling and consideration of complaints made under the regulations about—
	(a) the discharge by a local authority in Wales of any of its social services functions;
	(b) the provision of services by another person pursuant to arrangements made by such an authority in the discharge of those functions;
	(c) the provision of services by such an authority or any other person in pursuance of arrangements made by the authority under section 31 of the Health Act 1999 (c.8) in relation to the functions of an NHS body (within the meaning of that section).
	(4) Regulations under subsection (3) may provide for a complaint to be considered by one or more of the following—
	(a) the local authority in respect of whose functions the complaint is made;
	(b) an independent panel established under the regulations;
	(c) any other person or body.
	(5) Regulations under this section may provide for a complaint or any matter raised by a complaint—
	(a) in the case of regulations under subsection (1), to be referred to the Commission for Local Administration in England for it to consider whether to investigate the complaint or matter under Part 3 of the Local Government Act 1974) (and to be treated as if it had been duly made under section 26 of that Act);
	(b) in the case of regulations under subsection (3), to be referred to the Commission for Local Administration in Wales for it to consider whether to investigate the complaint or matter under Part 3 of that Act (and to be treated as if it had been duly made under section 26 of that Act);
	(c) to be referred to any other person or body for him or it to consider whether to take any action otherwise than under the regulations.
	(6) Regulations under this section may not make provision about complaints capable of being considered as representations under section 24D or section 26 of the Children Act 1989 (c.41).'.—[Dr. Ladyman.]
	Brought up, read the First and Second time, and added to the Bill.

New Clause 32
	 — 
	Complaints Regulations: Supplementary

'(1) Regulations under subsection (1) or (2) of section (Complaints about health care) or under subsection (1) or (3) of section (Complaints about social services) ("the regulations") may, without prejudice to the generality of the subsection under which they are made, make the following provision.
	(2) The regulations may make provision about—
	(a) the persons who may make a complaint;
	(b) the complaints which may, or may not, be made under the regulations;
	(c) complaints which need not be considered;
	(d) the period within which complaints must be made;
	(e) the procedure to be followed in making and considering a complaint;
	(f) matters which are excluded from consideration;
	(g) the making of a report or recommendations about a complaint;
	(h) the action to be taken as a result of the complaint.
	(3) The regulations may require—
	(a) the making of a payment, in relation to the consideration of a complaint under the regulations, by any person or body in respect of whom the complaint is made;
	(b) any such payment to be—
	(i) made to such person or body as may be specified in the regulations; and
	(ii) of such amount as may be specified in, or calculated or determined under, the regulations;
	(c) an independent panel to review the amount chargeable under paragraph (a) in any particular case and, if the panel thinks fit, to substitute a lesser amount.
	(4) The regulations may also—
	(a) provide for different parts or aspects of a complaint to be treated differently;
	(b) require the production of information or documents in order to enable a complaint to be properly considered;
	(c) authorise the disclosure of information or documents relevant to a complaint to a person or body—
	(i) who is considering a complaint under the regulations; or
	(ii) to whom a complaint has been referred;
	and any such disclosure may be authorised notwithstanding any rule of common law that would otherwise prohibit or restrict the disclosure.
	(5) The regulations may make provision about complaints which raise both matters falling to be considered under the regulations and matters falling to be considered under other statutory complaints procedures, including in particular provision for—
	(a) enabling such a complaint to be made under the regulations; and
	(b) securing that matters falling to be considered under other statutory complaints procedures are treated as if they had been raised in a complaint made under the appropriate procedures;
	and in this subsection "statutory complaints procedures" means procedures established by or under any enactment.'.—[Dr. Ladyman.]
	Brought up, read the First and Second time, and added to the Bill.

New Clause 33
	 — 
	Representations Relating to Special Guardianship Support Services

'(1) In section 26 of the Children Act 1989 (c.41) (representations), after subsection (3B) insert—
	"(3C) The duty under subsection (3) extends to any representations (including complaints) which are made to the authority by—
	(a) a child with respect to whom a special guardianship order is in force,
	(b) a special guardian or a parent of such a child,
	(c) any other person the authority consider has a sufficient interest in the welfare of such a child to warrant his representations being considered by them, or
	(d) any person who has applied for an assessment under section 14F(3) or (4),
	about the discharge by the authority of such functions under section 14F as may be specified by the Secretary of State in regulations."
	(2) Section 14G of that Act (special guardianship support services: representations) shall cease to have effect.'.—[Dr. Ladyman.]
	Brought up, read the First and Second time, and added to the Bill.

New Clause38
	 — 
	Joint Annual Reviews

'(1) Regulations made by the Secretary of State may provide that, where services of a description specified in the regulations are provided under arrangements under section 31 of the Health Act 1999 (c.8), the CHAI and the CSCI shall jointly—
	(a) review the provision by the parties to the arrangements of such services as may be specified in the regulations;
	(b) award a performance rating in respect of those services.
	(2) The regulations may provide that the CHAI and the CSCI are to exercise their functions under this section—
	(a) at such times as may be specified in the regulations;
	(b) by reference to criteria determined by the CHAI and the CSCI and approved by the Secretary of State.
	(3) The regulations may require the CHAI and the CSCI to publish a report after conducting a review under this section.'—[Dr. Ladyman.]
	Brought up, and read the First time.

Stephen Ladyman: I beg to move, That the clause be read a Second time.

Madam Deputy Speaker: With this it will be convenient to discuss the following:
	New clause 2—Duty of the CHAI to prepare standards guidance relating to health care—
	'(1) It shall be the duty of the CHAI to prepare guidance to assist in securing the raising of standards in health care.
	(2) In preparing guidance for the purposes of subsection (1), the CHAI shall have regard to performance indicators relating to—
	(a) the availability of, and access to, health care;
	(b) the quality and effectiveness of the health care provided to patients; and
	(c) the financial and other management of the delivery of the health care to patients.
	(3) The CHAI must—
	(a) lay a copy of any guidance prepared in accordance with the provisions of this section before Parliament, and
	(b) once they have done so, send a copy of it to the Secretary of State.'.
	New clause 3—Duty of the CSCI to prepare standards guidance relating to social care—
	'(1) It shall be the duty of the CSCI to prepare guidance to assist in securing the raising of standards in social care.
	(2) In preparing guidance for the purposes of subsection (1), the CSCI shall have regard to performance indicators relating to—
	(a) the availability of, and access to, social care services;
	(b) the quality and effectiveness of the social care services provided to the public; and
	(c) the management of the delivery of the social care services.
	(3) The CSCI must—
	(a) lay a copy of any guidance prepared in accordance with the provisions of this section before Parliament, and
	(b) once they have done so, send a copy of it to the Secretary of State.'.
	New clause 4—Duty of the CHAI to prepare standards guidance relating to health care in Wales—
	'(1) It shall be the duty of the CHAI to prepare guidance to assist in securing the raising of standards in health care in Wales.
	(2) In preparing guidance for the purposes of subsection (1), the CHAI shall have regard to performance indicators relating to—
	(a) the availability of, and access to, health care;
	(b) the quality and effectiveness of the health care provided to patients; and
	(c) the financial and other management of the delivery of the health care to patients.
	(3) The CHAI must—
	(a) lay a copy of any guidance prepared in accordance with the provisions of this section before Parliament, and
	(b) once they have done so, send a copy of it to the Secretary of State and the Assembly.'.
	New clause 5—Duty of the CSCI to prepare standards guidance relating to social care in Wales—
	'(1) It shall be the duty of the CSCI to prepare guidance to assist in securing the raising of standards in social care in Wales.
	(2) In preparing guidance for the purposes of subsection (1), the CSCI shall have regard to performance indicators relating to—
	(a) the availability of, and access to, social care services;
	(b) the quality and effectiveness of the social care services provided to the public; and
	(c) the management of the delivery of the social care services.
	(3) The CSCI must—
	(a) lay a copy of any guidance prepared in accordance with the provisions of this section before Parliament, and
	(b) once they have done so, send a copy of it to the Secretary of State and the Assembly.'.
	Amendment No. 38, in clause 41, page 14, line 23, at end insert—
	'(1A) The Secretary of State must publish all such statements and must publish a statement of the evidence-base upon which these standards are set'.'.
	Amendment No. 39, in page 14, line 24, leave out from 'may' to end of line 25 and insert
	'amend the standards whenever he considers it appropriate.
	(2A) The Secretary of State must publish amended statements, and must publish a statement of the evidence-base of the statements.'.
	Government amendment No. 359.
	Amendment No. 1, in clause 45, page 15, line 34, leave out from 'must' to end of line and insert
	'undertake an assessment of the performance of each such body in relation to the guidance issued under section [duty of the CHAI to prepare standards guidance relating to health care]'.
	Government amendments Nos. 360 to 370 and 372 to 377.
	Amendment No. 226, in clause 70, page 28, line 20, at end insert
	'of vulnerable adults and of people with disability'.
	Government amendments Nos. 379 and 380.
	Amendment No. 2, in clause 73, page 29, line 14, leave out from 'must' to end of line and insert
	'undertake an assessment of the performance of that authority in relation to the guidance issued under section [duty of the CSCI to prepare standards guidance relating to social care]'.
	Government amendments Nos. 381 and 382.
	Amendment No. 3, in clause 75, page 30, line 24, leave out from 'CSCI' to 'a' and insert
	'concludes as a result of an assessment that there is significant cause for concern about the effectiveness of the performance of'.
	Government amendment No. 383.
	Amendment No. 23, in clause 88, page 35, line 33, leave out paragraph (b) and insert—
	'(b) undertake an assessment of the performance of each such body in relation to the guidance issued under section [duty of the CHAI to prepare standards guidance relating to health care in Wales]'.
	Government amendments Nos. 384 to 386.
	Amendment No. 56, in clause 114, page 51, line 5 at end insert—
	'(5) Regulations may make further provision—
	(a) for prescribed functions of the CSCI to be exercised by CHAI on behalf of the CSCI;
	(b) for prescribed functions of the CHAI, so far as exercisable in relation to England, to be exercised by the CSCI on behalf of the CHAI.'.
	Government amendments Nos. 387 to 396.
	Amendment No. 57, in schedule 5, page 117, line 36, at end insert—
	'(4) The CHAI must consult and have regard to the advice of the Children's Rights Director under Schedule 6(5)(2) in discharging its functions under section 43(2)(d).'.
	Amendment No. 58, in page 119, line 14, at end insert
	'and is to be responsible to it for the general exercise of its functions'.
	Amendment No. 59, in page 122, line 12, at end insert
	'and is to be responsible to it for the general exercise of its functions'.

Stephen Ladyman: New clause 38 allows CHAI and CSCI to conduct jointly a review of services of a prescribed description provided under section 31 of the Health Act 1999, including reviews of care trusts. The aim of the new clause is to seek maximum flexibility to enable CHAI and CSCI to carry out, where appropriate, a joint review of services provided to the NHS and local authorities in partnership. We recognise and welcome the fact that the number and type of services provided under section 31 partnerships are constantly growing. We wish to allow for the possibility that in future it might be appropriate for CHAI and CSCI to carry out a joint review of certain services provided under a partnership and to award a performance rating in respect of those joint services.

Patrick Cormack: On a point of order, Madam Deputy Speaker. Could we have English spoken in this Chamber, not these extraordinary mnemonics and so on? Can the Minister explain what he is saying?

Madam Deputy Speaker: Order. Perhaps Dr. Ladyman can respond to that point of order.

Stephen Ladyman: I certainly can. The Commission for Healthcare Audit and Inspection and the Commission for Social Care Inspection are often referred to as CHAI and CSCI for the sake of speed.
	We wish to allow for the growth of organisations where those two services will have joint responsibilities. We want them to have the flexibility to be able to work together. For example, we may choose to provide in regulations that all adult mental health services provided under a section 31 partnership should be subject to a joint performance review under the clause. The Commission for Healthcare Audit and Inspection and the Commission for Social Care Inspection would be responsible for drawing up criteria under that section, which might include aspects such as how joined up and seamless was the provision of services under the partnership. The services provided under the partnership would still receive separate performance ratings for their health and social care elements, but we felt that it would be useful to have a separate rating to be able to judge the added value that the partnership had given to the service provision. We will consult all relevant stakeholders closely before drawing up any regulations under the provision and prescribing the services that will be subject to a joint review. I hope that that goes some way towards tackling the anxieties that the hon. Member for Sutton and Cheam (Mr. Burstow) expressed earlier about our determination that both organisations should work closely together.
	Government amendment No. 359 has been tabled in response to a commitment that the former Under-Secretary of State for Health, my hon. Friend the Member for Tottenham (Mr. Lammy) made in Committee. That shows the hon. Member for West Chelmsford (Mr. Burns), who has unfortunately left his place, that my hon. Friend listened in Committee and was prepared to respond to good points.
	The amendment makes it clear that the Commission for Healthcare Audit and Inspection will be concerned with all the factors in clause 43(2) when it exercises any of its functions that relate to NHS health care, not only the functions to which that provision currently refers.
	The list of the Commission for Healthcare Audit and Inspection's functions in clause 43(2) will be extended to include giving advice and information under clauses 49 to 50 to the appropriate authority—my right hon. Friend the Secretary of State, the Assembly or the regulator—reviewing data obtained by others in relation to providing health care and any conclusions drawn from such analysis under clause 51; and promoting the effective co-ordination of reviews or assessments that other bodies undertake under clause 52.
	The amendment will therefore ensure that, in discharging those functions, as well as the functions under clauses 44 to 48, the commission will pay particular attention to availability and access; quality and effectiveness; and the economy and efficiency of providing health care. In discharging those functions, the commission, as specified in clause 43(2)(d) and (e), will also concern itself with the need to safeguard and promote the rights and welfare of children and the effectiveness of NHS bodies or persons who provide—or are to provide—health care.
	We gave assurances in Committee that we would consider further the application of the clause and I therefore hope that Opposition Members will support amendment No. 359.
	Government amendments Nos. 360 and 361 are among the cluster of amendments that we are considering. Amendment No. 360 amends clause 46 to ensure that the Commission for Healthcare Audit and Inspection can undertake a review of the overall provision of health care by and for NHS bodies in England and Wales. We are taking the opportunity to clarify the function because the clause as currently drafted technically enables the commission to review only health care of a specific description. Without the amendment, the commission might carry out a review of cancer services in England and Wales but not of NHS care more generally.
	Amendment No. 360 aligns clause 46 with clause 47 when amended by amendment No. 363 expressly to enable the commission to review the overall provision of health care by or for English NHS bodies and cross-border strategic health authorities.
	Amendment No. 361 would ensure that my right hon. Friend the Secretary of State could request the commission to undertake such a review, should he consider one necessary. That will enable my right hon. Friend to ensure that the commission undertakes such necessary work so that issues of interest to the public or Parliament will receive the required attention from the inspectorate.
	I shall not speak in detail about the other Government amendments, but, if I get the opportunity to do so, I shall happily respond to any points later in the debate.

Chris Grayling: In the few moments available, I want to concentrate on new clause 2 and amendment No. 1. Before I do that, I emphasise that it is a shame that the Government did not see fit to include in new clause 38, which deals with joint annual reviews, provision for joint reviews between England and Wales to avoid the huge duplication that the measure will cause across borders.
	New clause 2 gives CHAI the right to participate in the process of setting standards. Under the Bill, it is the duty of the Secretary of State alone to prepare standards for health care. Conservative Members believe that that is unacceptable. That is doubly true when the Bill gives the new Secretary of State, who, by his own admission, has limited knowledge and experience of health care, the power to frame standards. There is no involvement of the Commission for Healthcare Audit and Improvement, which has the job of monitoring and tracking the performance of our health care system and understanding when it is and is not doing well. We believe that CHAI should be formally involved in the process, and new clause 2 would enable that to happen. I intend—with your consent, Madam Deputy Speaker—to press new clause 2 to a vote.
	Amendment No. 1 returns the debate to what is, in our view, one of the big handicaps and impediments confronting the health service: the star-rating system, an ill-judged, ill-thought-out process that sets hospital against hospital, causes confusion in both clinical and management sectors, and throws up extraordinary anomalies.
	Let me, in the few minutes available to me, give a clear explanation and a clear example of the problem, with reference to the Audit Commission's recently published report "Achieving the NHS Plan". Three hospitals are cited. Of the first it is said:
	"This Acute Trust performed poorly in relation to NHS Plan targets, and was rated as poor managerially".
	According to the second case study,
	"This Specialist Acute Trust achieved most NHS Plan targets, and was rated as 'very good' on the majority of measures of financial and performance management".
	Pretty good, really. As for the third example,
	"This Acute Trust has performed poorly in relation to NHS Plan targets, and the auditor noted significant financial management failings, without identifying any substantial signs of imminent improvement."
	What do those three hospitals have in common? The first, which performed poorly in relation to NHS plan targets, was awarded two stars by the Department of Health. The second, which performed well, was awarded two stars. The third, which performed poorly and showed no substantial signs of imminent improvement, was awarded two stars.
	The current star-rating system is a disgrace, which is founded on poor statistics and bears no relation to the true clinical performance of hospital trusts. As my hon. Friend the Member for Woodspring (Dr. Fox) said this afternoon, there are good hospitals in this country that are stuck with zero star ratings and all the handicaps that that entails. The star-rating system should go. It should be replaced by a system shaped by CHAI, on the basis of its experience of what is good and what is bad in our health service. CHAI should be given an active role in helping to shape the standards for health care.
	I want to press new clause 2 and amendment No. 1 to the vote, because I believe that they would make a real and positive difference to health care, and would help to get the politicians out of the health service.

Paul Burstow: I want to speak, exceedingly briefly, on amendments Nos. 38, 39, 56 and 59. In all of them the key issues are who decides standards, the process for setting them, and whether that should be entirely within the Secretary of State's remit or the commissions should play a role. That goes to the heart of the question whether the commissions are genuinely independent from the Secretary of State, or independent only at the pleasure of the Secretary of State. At present the Bill is inadequate, because the commissions are beholden to the Secretary of State in regard to much of what they must do.
	Amendments Nos. 38 and 39 would require the Secretary of State or indeed the commissions, when publishing standards, to have an evidence base and to refer specifically to the evidence. That strikes me as a sensible proposition, on which a thinking Minister might wish to reflect.
	We will support both the amendments that will shortly be put to the vote, not least because we believe that the star-rating system is deeply corrosive of the national health service. It misleads patients, and does not provide an adequate or reliable measure of what NHS performance actually is. It should be swept aside, and replaced by something that is more objective and more independent. We presented that argument in Committee in rather greater detail than I can present it now, but I hope that there will be more time to discuss it in the other place.

Madam Deputy Speaker: Order. Time is up.

Patrick Cormack: On a point of order, Madam Deputy Speaker. May I put on record that the debate has not been concluded, and that two subjects of great importance to your constituents and mine, and everyone else's, have not even been touched on? Will you please report that to Mr. Speaker when you ask him about taking Division time out of programme time?

Andrew Lansley: Further to that point of order, Madam Deputy Speaker. Would it be appropriate also to note that I sought to discuss new clause 22, which stands in my name, in Committee, but it was not reached by virtue of the time limitations imposed in Committee? So this is the second time that it has not been debated.

Madam Deputy Speaker: I am very mindful of what Members have said, but as I am sure that they will appreciate, I am bound by the programme order.
	It being more than four and three quarter hours after the commencement of proceedings on the programme motion, Madam Deputy Speaker proceeded to put forthwith the Questions necessary for the disposal of the business to be concluded at that hour, pursuant to Order [this day].
	 Question put and agreed to.
	Clause read a Second time, and added to the Bill.

New Clause 2
	 — 
	Duty of The CHAI to Prepare Standards Guidance Relating to Health Care

'(1) It shall be the duty of the CHAI to prepare guidance to assist in securing the raising of standards in health care.
	(2) In preparing guidance for the purposes of subsection (1), the CHAI shall have regard to performance indicators relating to—
	(a) the availability of, and access to, health care;
	(b) the quality and effectiveness of the health care provided to patients; and
	(c) the financial and other management of the delivery of the health care to patients.
	(3) The CHAI must—
	(a) lay a copy of any guidance prepared in accordance with the provisions of this section before Parliament, and
	(b) once they have done so, send a copy of it to the Secretary of State.'.
	Brought up, and read the First time.
	Motion made, and Question put, That the clause be read a Second time:—
	The House divided: Ayes 189, Noes 344.

Question accordingly negatived.

Clause 43
	 — 
	Introductory

Amendment made: No. 359, in page 15, line 16, leave out '48' and insert '52'.—[Dr. Ladyman.]

Clause 46
	 — 
	General Reviews

Amendments made: No. 360, in page 16, line 10, at end insert—
	'(za) the overall provision of health care by and for NHS bodies;'.
	No. 361, in page 16, line 15, at end insert—
	'( ) a review under subsection (1)(za)'.
	No. 362, in page 16, line 34, leave out from 'publish' to end of line 35 and insert 'a report'.—[Dr. Ladyman.]

Clause 47
	 — 
	Other Reviews and Investigations

Amendments made: No. 363, in page 16, line 38, leave out from 'by' to end of line 40 and insert
	'and for English NHS bodies and cross-border SHAs.
	(1A) The CHAI may in particular under this section conduct—
	(a) a review of the overall provision of health care by and for English NHS bodies and cross-border SHAs;
	(b) a review of the overall provision of a particular kind of health care by and for English NHS bodies and cross-border SHAs;
	(c) a review of, or investigation into, the provision of any health care by or for a particular English NHS body or cross-border SHA.'.
	No. 364, in page 16, line 42, leave out from 'by' to 'duty' in line 1 on page 17 and insert
	'English NHS bodies and cross-border SHAs for the purpose of discharging their'.
	No. 365, in page 17, line 2, leave out from 'conduct' to 'as' in line 4 and insert—
	'(a) a review under subsection (1A)(a);
	(b) a review under subsection (1A)(b) of the overall provision of a kind of health care specified in the request;
	(c) a review or investigation under subsection (1A)(c), or a review under subsection (2), in relation to the provision of such health care by or for such body'.
	No. 366, in page 17, line 10, leave out
	'the NHS body in question'
	and insert
	'any English NHS body or cross-border SHA'.
	No. 367, in page 17, line 11, leave out 'that' and insert 'such a'.
	No. 368, in page 17, line 14, leave out from 'publish' to end of line and insert 'a report'.—[Dr. Ladyman.]

Clause 48
	 — 
	Failings

Amendments made: No. 369, in page 17, line 27, leave out 'person' and insert 'body'.
	No. 370, in page 17, line 41, leave out 'other person' and insert 'body'.
	No. 371, in page 18, line 15, leave out 'person' and insert 'body'.—[Dr. Ladyman.]

Clause 51
	 — 
	Reviews of Data

Amendment made: No. 372, in page 19, line 14, leave out from 'publish' to end of line 15 and insert 'a report'.—[Dr. Ladyman.]

Clause 53
	 — 
	Studies as to Economy, Efficiency Etc

Amendment made: No. 373, in page 19, line 32, leave out
	'at least a summary of'
	and insert
	'its recommendations and'.—[Dr. Ladyman.]

Clause 64
	 — 
	Reviews and Investigations Relating to Wales

Amendments made: No. 374, in page 25, line 5, leave out from 'conducting' to end of line 11 and insert
	'reviews of, and investigations into, the provision of health care by and for Welsh NHS bodies.
	(1A) The Assembly may in particular under this section conduct—
	(a) a review of the overall provision of health care by and for Welsh NHS bodies;
	(b) a review of the overall provision of a particular kind of health care by and for Welsh NHS bodies;
	(c) a review of, or investigation into, the provision of any health care by or for a particular Welsh NHS body.
	(1B) The Assembly has the function of conducting reviews of the arrangements made by Welsh NHS bodies for the purpose of discharging their duty under section 40.'.
	No. 375, in page 25, line 12, leave out 'subsection (1)' and insert 'this section'.
	No. 376, in page 25, line 25, leave out 'subsection (1)' and insert 'this section'.
	No. 377, in page 25, line 30, leave out from 'publish' to end of line 31 and insert 'a report'.—[Dr. Ladyman.]

Clause 65
	 — 
	Reporting to Secretary of State

Amendment made: No. 378, in page 26, line 6, at end insert—
	'(2A) The Assembly must report to the regulator where, after conducting a review or investigation under section 64, it is of the view that—
	(a) there are significant failings in relation to the provision of health care by or for an NHS foundation trust;
	(b) there are significant failings in the running of an NHS foundation trust; or
	(c) there are significant failings in the running of any body, or the practice of any individual, providing health care for an NHS foundation trust.
	(2B) A report under subsection (2A) may include a recommendation that, with a view to remedying the failings, the regulator take special measures in relation to the NHS foundation trust.'.—[Dr. Ladyman.]

Clause 71
	 — 
	Information and Advice

Amendment made: No. 379, in page 28, line 33, at end insert
	', in the standards prepared and published from time to time under section 23 of that Act'.—[Dr. Ladyman.]

Clause 72
	 — 
	Review of Studies and Research

Amendment made: No. 380, in page 29, line 7, leave out from 'publish' to end of line 8 and insert 'a report'.—[Dr. Ladyman.]

Clause 73
	 — 
	Annual Reviews

Amendment made: No. 381, in page 29, line 19, leave out 'function' and insert 'functions'.—[Dr. Ladyman.]

Clause 74
	 — 
	Other Reviews and Investigations

Amendment made: No. 382, in page 30, line 19, leave out from 'publish' to end of line and insert 'a report'.—[Dr. Ladyman.]

Clause 76
	 — 
	Studies as to Economy, Efficiency etc

Amendment made: No. 383, in page 31, line 27, leave out
	'at least a summary of'.—[Dr. Ladyman.]

Clause 88
	 — 
	Reviews and Investigations

Amendment made: No. 384, in page 35, line 38, leave out from 'publish' to end of line and insert 'a report'.—[Dr. Ladyman.]

Clause 92
	 — 
	Right of Entry

Amendment made: No. 385, in page 37, line 9, leave out from 'inspect' to end of line 16 and insert—
	'(a) any premises owned or controlled by a local authority in Wales;
	(b) any premises falling within subsection (1A), other than premises used wholly or mainly as a private dwelling.
	(1A) The premises referred to in subsection (1)(b) are premises—
	(a) which are used, or proposed to be used, by any person in connection with the provision of a Welsh local authority social service; or
	(b) which the Assembly reasonably believes to be so used, or proposed to be so used.'.—[Dr. Ladyman.]

Clause 105
	 — 
	Boarding Schools and Colleges: Reports

Amendment made: No. 386, in page 43, leave out lines 24 to 26 and insert—
	'"(9A) Where the Commission or the National Assembly for Wales exercises the power conferred by subsection (5), it must publish a report.'.—[Dr. Ladyman.]

Clause 107
	 — 
	Complaints About Health Care: English and Cross-Border Bodies

Amendment made: No. 301, in page 44, line 6, leave out clause 107.—[Dr. Ladyman.]

Clause 108
	 — 
	Complaints About Health Care: Welsh Bodies

Amendment made: No. 302, in page 45, line 20, leave out clause 108.—[Dr. Ladyman.]

Clause 109
	 — 
	Complaints About Social Services: England

Amendment made: No. 303, in page 46, line 32, leave out clause 109.—[Dr. Ladyman.]

Clause 110
	 — 
	Complaints About Social Services: Wales

Amendment made: No. 304, in page 47, line 42, leave out clause 110.—[Dr. Ladyman.]

Clause 111
	 — 
	Complaints Under The Children Act 1989

Amendments made: No. 305, in page 49, line 13, leave out from beginning of line to end of line 45 and insert—
	'(2) The regulations may in particular make provision—
	(a) for the further consideration of a representation by the Commission for Social Care Inspection ("the CSCI");
	(b) for a representation to be referred by the CSCI for further consideration by an independent panel established under the regulations;
	(c) about the procedure to be followed on the further consideration of a representation;
	(d) for the making of recommendations about the action to be taken as the result of a representation;
	(e) about the making of reports about a representation;
	(f) about the action to be taken by the local authority concerned as a result of the further consideration of a representation;
	(g) for a representation to be referred by the CSCI back to the local authority concerned for reconsideration by the authority;
	(h) for a representation or any matter raised by the representation to be referred by the CSCI—
	(i) to the Commission for Local Administration in England for it to consider whether to investigate the representation or matter under Part 3 of the Local Government Act 1974 as if it were a complaint duly made under section 26 of that Act; or
	(ii) to any other person or body for him or it to consider whether to take any action otherwise than under the regulations.
	(3) The regulations may require—
	(a) the making of a payment, in relation to the further consideration of a representation under this section, by any local authority in respect of whose functions the representation is made;
	(b) any such payment to be—
	(i) made to such person or body as may be specified in the regulations;
	(ii) of such amount as may be specified in, or calculated or determined under, the regulations;
	(c) an independent panel to review the amount chargeable under paragraph (a) in any particular case and, if the panel thinks fit, to substitute a lesser amount.
	(4) The regulations may also—
	(a) provide for different parts or aspects of a representation to be treated differently;
	(b) require the production of information or documents in order to enable a representation to be properly considered;
	(c) authorise the disclosure of information or documents relevant to a representation—
	(i) to a person or body who is further considering a representation under the regulations; or
	(ii) to the Commission for Local Administration in England (when a representation is referred to it under the regulations);
	and any such disclosure may be authorised notwithstanding any rule of common law that would otherwise prohibit or restrict the disclosure.".'.
	No. 306, in page 49, line 45, at end insert—
	'(1A) After section 26ZA of that Act (as inserted by subsection (1)) insert—
	"26ZB Representations: further consideration (Wales)
	(1) The Secretary of State may by regulations make provision for the further consideration of representations which have been considered by a local authority in Wales under section 24D or section 26.
	(2) The regulations may in particular make provision—
	(a) for the further consideration of a representation by an independent panel established under the regulations;
	(b) about the procedure to be followed on the further consideration of a representation;
	(c) for the making of recommendations about the action to be taken as the result of a representation;
	(d) about the making of reports about a representation;
	(e) about the action to be taken by the local authority concerned as a result of the further consideration of a representation;
	(f) for a representation to be referred back to the local authority concerned for reconsideration by the authority.
	(3) The regulations may require—
	(a) the making of a payment, in relation to the further consideration of a representation under this section, by any local authority in respect of whose functions the representation is made;
	(b) any such payment to be—
	(i) made to such person or body as may be specified in the regulations;
	(ii) of such amount as may be specified in, or calculated or determined under, the regulations; and
	(c) for an independent panel to review the amount chargeable under paragraph (a) in any particular case and, if the panel thinks fit, to substitute a lesser amount.
	(4) The regulations may also—
	(a) provide for different parts or aspects of a representation to be treated differently;
	(b) require the production of information or documents in order to enable a representation to be properly considered;
	(c) authorise the disclosure of information or documents relevant to a representation to a person or body who is further considering a representation under the regulations;
	and any such disclosure may be authorised notwithstanding any rule of common law that would otherwise prohibit or restrict the disclosure.".'.
	No. 307, in page 50, line 5, after '26ZA', insert 'or 26ZB'.—[Dr. Ladyman.]

Clause 112
	 — 
	Complaints About Handling of Complaints

Amendment made: No. 308, in page 50, line 13, leave out from beginning to end of line 18 and insert
	'any person or body in the exercise of any function under section (Complaints about health care) of the Health and Social Care (Community Health and Standards) Act 2003 (complaints about health care)'.—[Dr. Ladyman.]

Clause 113
	 — 
	Complaints: Data Protection

Amendments made: No. 309, in page 50, line 25, leave out
	'107, 108, 109, or 110'
	and insert
	'(Complaints about health care) (1) or (2) or (Complaints about social services) (1) or (3).
	No. 310, in page 50, line 27, leave out 'or 26ZA' insert ', 26ZA or 26ZB'.—[Dr. Ladyman.]

Clause 121
	 — 
	Annual Reports: CHAI

Amendments made: No. 387, in page 53, line 28, at end insert—
	'( ) what it has found in the course of exercising its functions during the year in relation to the persons for whom it is the registration authority under the Care Standards Act 2000 (c.14).'—[Dr. Ladyman.]
	No. 388, in page 53, line 29, leave out subsection (2).
	No. 389, in page 53, line 34, at end insert—
	'( ) The CHAI must also provide the Secretary of State with such reports and information relating to the exercise of its functions as he may from time to time request.'—[Dr. Ladyman.]

Clause 127
	 — 
	Inquiries: CHAI

Amendments made: No. 390, in page 55, line 27, leave out subsection (1) and insert—
	'(1) The Secretary of State may cause an inquiry to be held into any matter connected with the exercise by the CHAI of any of its functions.
	(1A) The Assembly may cause an inquiry to be held into any matter connected with the exercise by the CHAI of any of its functions in relation to any health care provided by or for a Welsh NHS body.'
	No. 391, in page 55, line 30, leave out 'authority' and insert
	'Secretary of State or (in the case of an inquiry under subsection (1A)) the Assembly'.
	No. 392, in page 55, line 38, leave out 'authority' and insert
	'Secretary of State or (in the case of an inquiry under subsection (1A)) the Assembly'.
	No. 393, in page 56, line 1, leave out 'appropriate authority' and insert
	'Secretary of State or (in the case of an inquiry under subsection (1A)) the Assembly'.
	No. 394, in page 56, line 3, leave out subsection (7).—[Dr. Ladyman.]

Clause 130
	 — 
	Section 129: Defence

Amendment made: No. 311, in page 57, line 18, leave out '107 (complaints)' and insert
	'(Complaints about health care) (complaints about health care)'.—[Dr. Ladyman.]

Clause 131
	 — 
	Information Obtained by CHAI: Supplementary

Amendment made: No. 395, in page 58, line 1, leave out subsection (2) and insert—
	'(2) Where subsection (3) applies, the CHAI may disclose any information obtained by it notwithstanding any rule of common law which would otherwise prohibit or restrict the disclosure.
	(3) This subsection applies where—
	(a) in the case of information relating to an individual, the circumstances in paragraph (a) or (b) of subsection (2) of section 130 apply in relation to the disclosure;
	(b) in any case, the circumstances in any of paragraphs (c) to (g) of that subsection apply in relation to the disclosure; or
	(c) in any case, the disclosure is made as specified in paragraph (a), (b) or (c) of subsection (3) of that section.
	(4) Subsection (4) of section 130 applies for the purposes of subsection (3)(a) above.'—[Dr. Ladyman.]

Clause 139
	 — 
	Interpretation of Part 2

Amendments made: No. 396, in page 60, line 2, leave out from 'Authority' to end of line 3 and insert
	'not performing functions only or mainly in respect of England or only or mainly in respect of Wales'.
	No. 312, in page 60, line 46, leave out '95, 108 and 110' and insert 'and 95'.—[Dr. Ladyman.]

Schedule 8
	 — 
	Part 2: Minor and Consequential Amendments

Amendments made: No. 316, in page 126, line 17, leave out 'Sections 109 and 110' and insert
	'Section (Complaints about social services)'
	.
	No. 317, in page 126, line 31, leave out '107 or 108' and insert
	'(Complaints about health care)(1) or (2)'
	.
	No. 318, in page 127, line 17, leave out '107 or 108' and insert
	'(Complaints about health care)(1) or (2)'.—[Dr. Ladyman.]

New Clause 26
	 — 
	Provision of Primary Medical Services

'In the 1977 Act, after section 16CB (as inserted by section 162 above) insert—
	"16CC Primary medical services
	(1) Each Primary Care Trust and Local Health Board must, to the extent that it considers necessary to meet all reasonable requirements, exercise its powers so as to provide primary medical services within its area, or secure their provision within its area.
	(2) A Primary Care Trust or Local Health Board may (in addition to any other power conferred on it)—
	(a) provide primary medical services itself (whether within or outside its area);
	(b) make such arrangements for their provision (whether within or outside its area) as it thinks fit, and may in particular make contractual arrangements with any person.
	(3) Each Primary Care Trust and Local Health Board must publish information about such matters as may be prescribed in relation to the primary medical services provided under this Part.
	(4) A body on which functions are conferred under this section must cooperate with any other such body in the discharge of their respective functions relating to the provision of primary medical services under this Part.
	(5) Regulations may provide that services of a prescribed description are, or are not, to be regarded as primary medical services for the purposes of this Part.
	(6) Regulations under this section may in particular describe services by reference to the manner or circumstances in which they are provided.".'.—[Mr. Hutton.]
	Brought up, and read the First time.

John Hutton: I beg to move, That the clause be read a Second time.

Madam Deputy Speaker: With this it will be convenient to discuss the following:
	Government new clause 27—General medical services contracts.
	And the following amendment thereto: (a), after 'appropriate', insert—
	'(4A) No direction issued under subsection (1) shall involve payment based on rewarding contractors for reaching a target number or target proportion of treatments given.'.
	Government new clause 28—Government medical services: transitional.
	Government new clause 29—Abolition of pilot schemes.
	New clause 40—Definition of personal medical service—
	'In the 1977 Act, in section 29(2), leave out "adequate" and, after "attendance", insert "to meet their clinical needs".'.
	Government amendments Nos. 270 to 299, 268, 269 and 300.

John Hutton: Following the recent decision by doctors in the British Medical Association to approve the new general medical services contract for family practitioners, the Government are taking the earliest possible opportunity to legislate for the necessary implementation. These clauses were not laid during earlier stages of the Bill's passage because we did not want to prejudge the outcome of the BMA ballot. As it turned out, 79.4 per cent. chose to support the new contract: 31,945 GPs cast a vote, which was a 70 per cent. turnout. That indicates the strength of support for the change.

Andrew Lansley: Will the Minister tell the House when the clauses and amendments were drafted? It may not necessarily have pre-empted the ballot, but it would have informed the House—notwithstanding the requirement for a positive vote in the ballot—if the clauses and amendments had been available for scrutiny earlier.

John Hutton: As the hon. Gentleman will understand, these amendments have been through several iterations in the Department and were not finally ready to be tabled until we were satisfied—as the BMA and the NHS Confederation were—that they provided the right legal framework to deliver the new contract. That was not until Thursday. I apologise to hon. Members and the House for the fact that the documentation that we sent out on Thursday did not reach them until Monday. That is regrettable and I apologise to the hon. Gentleman and other right hon. and hon. Members who take a close interest in these matters. We were genuinely trying to be helpful in that regard. I am sorry if it did not end up like that. To help Members understand the clauses, I wrote to them with an explanatory note last week. I hope that, despite the delays in reaching them, it has turned out to be at least some help for this afternoon's debate.
	In general terms, the new clauses are designed to achieve two things: first, to implement the new GMS contract as agreed overwhelmingly by general practitioners; and, secondly, to make provision for putting personal medical services arrangements on to a permanent basis, as originally envisaged in the 1997 Act, in order to reflect the success of PMS as a means of providing primary care services.
	In order to effect these changes, we need to give primary care trusts additional powers to commission primary medical services. In the process, our objectives have been to simplify the existing legal framework, to minimise the volume of secondary legislation—an inevitable by-product, I am afraid—and to make the new arrangements more straightforward for family doctors, patients and NHS organisations.
	New clause 26 replaces the existing duty on PCTs and local health boards to make arrangements for the provision of general medical services with a new duty to provide or to secure the provision of primary medical services. The primary care trust or the local health board can meet this duty by entering into general medical services contracts, personal medical services arrangements, through providing the service itself, or by commissioning services from other health care suppliers. New clauses 27 and 28 provide for the making of the new GMS contract and for the necessary transitional regulations.
	New clause 29 and amendments Nos. 278 to 282 will remove the pilot status of personal medical services arrangements and place PMS in the mainstream of delivering primary care services in the NHS. To do that, the power to make pilot schemes will be repealed, and sections 28C to 28E of the National Health Service Act 1977 will be commenced. As part of that process, several amendments will be introduced to sections 28C to 28E, simply to bring them up to date and, in particular, to reflect the changes made to the GMS provisions.
	Amendments Nos. 284 to 291 will amend clause 166 to provide for a single list of performers in primary medical services to be held by primary care trusts, replacing the existing three-list structure set out in the Health and Social Care Act 2001. It is a helpful streamlining of those arrangements.
	Amendments Nos. 292 to 295 will amend clause 167 to extend the assistance and support provisions to general medical services and personal medical services. Remaining amendments cover minor and consequential amendments and list the associated repeals.
	That is what each new clause and amendment does in a nutshell. I would now briefly like to explain that while the new clauses make significant and important changes to the old GMS arrangements, the new GMS contract will retain many of the features of traditional general practice. For example, primary care trusts and local health boards will be under a duty to secure or provide within their areas the provision of primary medical services, to the extent that the trusts or boards consider that necessary to meet all reasonable requirements. It is that legal responsibility to ensure a comprehensive package of commissioning arrangements in respect of primary medical services that underpins the very important patient services guarantee described in chapter 6 of the agreement. We have made copies of the framework agreement available in the Vote Office for right hon. and hon. Members to consult.
	Patients need to be assured that the new contractual arrangements do not deny them access to services, and they will not. The new arrangements do not envisage any diminution of the services currently provided under GMS contracts. Indeed, it is envisaged that most practices will continue to deliver the full range of additional services. Where they do not, the PCT must step in, and it is in those cases that a patient might need to go to another provider for certain services. The PCT will therefore have a power to commission services through other arrangements, including providing the services itself, if necessary. However, patients can expect the PCT to ensure that they continue to be offered at least the range of services that they currently enjoy under the existing GMS arrangements. That is the patient services guarantee.
	All GMS contracts must include a duty to provide essential services, including the management of patients who are ill, or believe themselves to be ill, for the duration of that condition; care for those who are terminally ill; and the management of chronic disease. Where additional services such as minor surgery are provided for patients—that will be the case in all PCT areas, albeit that every practice may not provide such services—existing practices in the PCT or local health board area will start off with a preferential right to provide such services and will normally be expected to do so.
	We are also retaining list-based general practice. In future, a patient will not be registered with an individual GP but will still be registered with a practice. A practice-based contract, rather than an individually based contract, will provide much more flexibility for the practice to decide how it delivers services. That will be a helpful degree of flexibility that we will provide for busy family doctors. For example, it will enable nurses to be contracting partners in the practice, which is not possible at the moment.
	Once registered with a practice, the patient will continue to have the right to request to be seen by the doctor of their choice. That is important for patients who value seeing their own GP, and I certainly count myself among that number. The PCT will also retain its ability to help patients who, for whatever reason, cannot register with a general practice. It will retain the ability to assign patients to general practice but can additionally, for example, arrange to provide primary medical services itself where that is an appropriate solution.

Patrick Cormack: My constituency has only two practices in which the doctors themselves provide all the out-of-hours services. All the rest contract out that provision. Will that situation change as a result of the Bill? I know from experience that patients prefer to see a doctor from the practice to which they are assigned, rather than some locum from far away.

John Hutton: I agree with the hon. Gentleman that those are important issues, and patients value that provision highly. The situation will change under the new contract that we have agreed with the BMA and the NHS Confederation. Essentially, it will be for GPs to choose whether to provide an out-of-hours service directly. The new contract will not remove the requirement to provide out-of-hours services, but it will change who has the responsibility to organise the delivery of that service. At the moment, GPs must provide it, and some provide it directly themselves. They will continue to be able to do so if they wish to, but increasingly, for a variety of reasons—including work-life balance and other lifestyle issues—GPs do not want that onerous responsibility to fall entirely on their practices. They are happy for the service to be delegated, which is what happens with GP co-ops and other providers. The agreement provides for the PCTs to take on the principal responsibility for organising local out-of-hours services. I hope that they will be provided by patients' own GPs in many cases, but that will have to be decided locally.

Andrew Murrison: Does the Minister agree that the Government are putting several new duties on primary medical care providers, which makes the out-of-hours provision mentioned by my hon. Friend the Member for South Staffordshire (Sir Patrick Cormack) impossible, if GPs are to achieve a work-life balance?

John Hutton: I have significant sympathy with that view, which is why the new agreement reached with the BMA and the NHS Confederation provides for the solution that I have just described. GPs will be able to opt out of the responsibility of providing out-of-hours services, mainly for the reasons that the hon. Gentleman suggests. It is important that we do not lose sight of the fact that family doctors voted overwhelmingly for the new contract. It is the right contract for the future of primary care and it strikes the right balance between the need to ensure that patients have access to effective services and that doctors have the chance to lead their own lives and balance their work with their family and other responsibilities. That is our aim.
	There has been some misunderstanding about the out-of-hours aspect of the agreement. Headlines in some newspapers claimed that there would be no 24-hour family doctor service. That is not what the new contract is all about. Such provision in the future will be the responsibility of the PCT or local health board, and that is where the responsibility should be located, not—as at present—with the busy family doctor.

Patrick Cormack: How will patients be affected? I presume that as far as they are concerned, the service will continue to be provided through the general practice.

John Hutton: Yes, that is how it is likely to be arranged. The usual arrangement of providing a telephone number for out-of-hours services will continue. One of the clauses that we shall discuss later provides for a new obligation on PCTs to provide such information to everyone in the area they serve. I would expect PCTs and local health boards to send out notes reminding people that the 24-hour services still exist and providing the telephone number. Some practices will decide to provide those services themselves and some will use other out-of-hours services providers, such as GP co-ops or private companies, which provide such services to many GPs now. Whatever the arrangements are, the maximum amount of information must be available to people locally, so that they know when and who to ring. That will be the responsibility of the PCTs.
	We will also retain PCTs' ability to make decisions about the suitability of general practitioners to provide primary medical services. We are simplifying the legislative process, but retaining all the effective and necessary controls, by merging the current multiple list system into a single list of primary care performers. The detail of the new contract is set out in the agreement document, called "Investing in General Practice", which was published on 26 February. Copies of it have been placed in the Library and the Vote Office.
	The new contract will be accompanied by a substantial additional investment of nearly £2 billion for primary care services across the UK. Funding will increase from £6.1 billion this year to £8 billion by 2005–06. That is 11 per cent. per year, each year, for the next three years.
	To implement the contract, it has been necessary to make significant amendments to the legislative basis on which general medical services are presently provided, and to repeal a significant amount of primary as well as secondary legislation. It is intended that, after the implementation and commencement of these provisions, the volume of delegated legislation will be less extensive and more transparent than at present. Subsections (5) and (6) of proposed new section 16CC, as inserted by new clause 26, provide regulation powers to clarify what should and should not be considered to be primary medical services. This power could be used, if necessary, to maintain a national range of primary medical services across all PCTs and local health boards.
	New clause 40, tabled by the hon. Member for Oxford, West and Abingdon (Dr. Harris), seeks to amend a primary care trust's duty to secure primary medical services and to require PCTs to meet the clinical needs of patients. His new clause removes the reference to "adequate" care. The existing duty set out in section 29 of the 1977 Act requires every primary care trust to make arrangements with individual medical practitioners to provide personal medical services, and for the recipients of those services to receive
	"adequate personal care and attendance".
	The PCT duty in proposed new section 16CC replaces that duty, and is intended to be no less stringent than the duty in the existing legislation.
	The duty on PCTs is to provide services to the extent that they consider necessary to meet all reasonable requirements. There was some discussion about this issue in Committee, as I am sure the hon. Member for Oxford, West and Abingdon, and the hon. Member for West Chelmsford (Mr. Burns) and the other Conservative Members on the Committee, will remember. They will probably not recall every nuance of the debate—I certainly do not—but I remember that this was registered as a problem. There was, for example, concern that the duty to commission primary dental services was not properly aligned with the duty to provide primary medical services. We have tried to deal with that particular problem in a subsequent amendment, which I shall come to in a moment.
	I had hoped that the wording of the duty in respect of primary medical services would provide a more direct read-across, which would satisfy the hon. Member for Oxford, West and Abingdon, following our discussions in Committee. As I said, we have tried to take on board the concerns that were expressed at that time. The similarity in wording for medical and dental services is appropriate because the provision of services by the PCT goes towards the fulfilment of the Secretary of State's duty under section 3 of the 1977 Act with regard to primary medical services.
	The problem with the new clause tabled by the hon. Member for Oxford, West and Abingdon is that it seeks to amend a section of the 1977 Act that we are about to repeal, so it would be difficult for me to accept it.

Evan Harris: We tabled that new clause at what we reasonably thought was the last minute, but it became clear yesterday when the Minister tabled his new clause that this was going to be the case. I accept what he has just said.

John Hutton: I am grateful to the hon. Gentleman for that, because we have taken away the comments that he and other hon. Members made and tried to amend the Bill to reflect their concerns. There is a problem with new clause 40 and I am grateful to him for clarifying that point. I assume that that means that he will not want to press the matter to a vote.
	Sadly, I also have a problem with the hon. Gentleman's amendment (a) to new clause 27, because it seeks to remove the ability of the Secretary of State to issue payments based on rewarding contractors for reaching a target or
	"target proportion of treatments given".
	The United Kingdom has one of the most successful vaccine programmes in the world, with high levels of uptake. It has been achieved by the hard work of general practitioners and enforced by the system of targeted financial incentives. The target payment scheme incentivises levels of uptake that protect children not only individually but collectively in the wider community, especially those for whom immunisation is contra-indicated. Removing the target payments could have a negative effect on vaccine uptake, and could perpetuate coverage that is insufficient for the protection of the wider community.
	I understand the hon. Gentleman's wider objections to targets; he and I have debated the matter extensively across the Floor of the House and elsewhere. I believe, however, that he is pursuing the wrong issue here. This particular method of incentivising achievement in primary care and general practice has worked; it has helped to protect the health and safety of children. On this issue, therefore, he might not have chosen the strongest ground on which to fight his battle.

Evan Harris: I accept the Minister's invitation not to go into the whole issue of targets in this debate, but in my speech I shall go into the reasons why, even if this system worked, it would give rise to major problems. Can he provide any evidence that the incentive payments for those vaccination targets have provided the cover that exists—questionable and dodgy though it is, because of other factors—or does he simply think that the system must be working because the incentive scheme exists and we have reasonable coverage? Is there any evidence?

John Hutton: I think that there is, and I should be happy to write to the hon. Gentleman setting out some of the trends involved in immunisation so that he can form his own view on the matter.
	On the future of this type of payment, the new contract makes it clear that we will be discussing with the BMA how we can use the target payments more effectively in a way that meets general practitioners' concerns—I acknowledge that such concerns exist—and encourages even higher uptake, protecting children from potentially life-threatening diseases.

Andrew Lansley: The Minister's exchange with the hon. Member for Oxford, West and Abingdon (Dr. Harris) did not touch on a particularly difficult issue relating to the contract and the target payments. The Minister will be aware that, in respect of this particular set of targets, exception reporting for informed dissent does not apply. The effect of that is that GPs are operating under a financial incentive to raise their level of compliance, regardless of the fact that parents might choose for their children not to have a particular vaccination. I have been consistent in my support of the childhood immunisation programme—including vaccinations for measles, mumps and rubella—but there is a serious question mark over this practice, as perceived by patients.

John Hutton: I certainly accept that, and I have taken part in some of the discussions with the BMA on precisely that issue. In the light of the new agreement, we clearly need to continue to discuss it with the association. I am talking here about the general principle, however, rather than about how the details of the payment mechanisms are working.

Andrew Lansley: It is in the contract, on page 8.

John Hutton: It is, but it is also clear from paragraph 2.11 of the agreement that we shall continue to discuss the detail of those arrangements with the BMA. That is the only point that I am trying to make.
	The second of the two principal purposes of these amendments is to make changes to the legislation on personal medical services—the alternative to general medical services. We have already considered the amendments necessary to implement the agreement between the BMA and the NHS Confederation for a new GMS contract. We have also looked at the new duty on PCTs to provide or secure the provision of primary medical services as set out in proposed new section 16CC. This will have an impact on other areas of primary care, including PMS schemes. The intention of new clause 29 and amendments Nos. 278 to 283 is, therefore, to provide the legal basis for changes to PMS that are, in the main, consequential to the new GMS contract.
	We are taking the opportunity to bring local PMS contracts into the mainstream of primary medical services. It is our intention that all existing PMS pilots will become mainstream with effect from 1 April 2004. The National Health Service (Primary Care) Act 1997, which was introduced by the previous Conservative Administration and supported by the then Labour Opposition, introduced the concept of personal medical and dental services, and inserted new sections 28C, 28D and 28E into the 1977 Act. However, the concept was considered at the time to be very different from the traditional national GMS agreements, so a period of piloting was provided for in part 1 of the 1997 Act.
	Personal medical service pilot schemes are voluntary—rightly so—and are intended to give GPs, nurses and primary care trusts the flexibility and opportunity to innovate by offering different options for addressing primary care needs that have to be met locally. It was always the intention, however, that, provided that PMS proved successful, the system would be made permanent. It has proved to be successful and we are therefore repealing part 1 of 1997 Act in respect of England and Wales. PMS will continue under the permanency arrangements that were set out in the 1997 Act. In other words, the legal basis of PMS switches to sections 28C to 28E of the 1977 Act. This also applies to personal dental service arrangements.
	This means that decisions can be made locally rather than nationally about individual schemes, now that we have moved beyond the pilot phase. The House will be aware that individual PMS schemes need to be approved by Ministers, but I believe that that is no longer necessary, and that we can move beyond that sort of centralism. The intention is that under the general transitional powers in the Bill we will issue an order that allows existing PMS agreements to continue, but automatically changes the legislative basis of those contracts to the 1977 legislation. All things being equal, that will have no impact at all on PMS providers unless there are variations to their PMS agreements. We are also making a number of other changes to the provisions in sections 28C, 28D and 28E, which are largely technical and reflect some of the changes brought about by the new general medical services contract provisions.
	That concludes the formal substance of my remarks, but I think that this is an important moment for primary care. We have had a strong, positive endorsement of the new contract from family doctors, and the House now has the means to give effect to it. I hope that Members on both sides of the House will support our new clauses, which command the support of the BMA and the NHS Confederation.

Simon Burns: May I begin by thanking the Minister? In Standing Committee, it emerged that large parts of the Bill relied heavily on the Government's regulation-making powers. We did not know how the Government intended to use regulations to build on the nuts and bolts of the Bill—this is not a criticism—because they were not yet in a position to share their views with Opposition parties or anyone else. However, towards the end of proceedings in Committee, the Minister said that he would seek to introduce new clauses and amendments on Report to incorporate the GP contract in the Bill, and gave a commitment to make available to Committee members explanatory notes and a briefing on the Government's proposals. That commitment was honoured, and the briefing and notes arrived yesterday morning. Of course, it would have been better and more convenient to have them over the weekend, but not getting them then was not the end of the world. In the first post yesterday we received an extensive briefing from the Minister, which will certainly assist us during today's proceedings. I thank the Minister for going to the bother of keeping us informed.
	As the Minister will be aware, five new clauses and 32 amendments have been tabled on the GP contract, so incorporating it in primary legislation constitutes an extensive addition to the Bill. The Minister was factually correct when he said that it had taken two years to get a GP contract, but he did not say that it had had a chequered history. The Government have had to make significant changes to the initial contract that they hoped to persuade GPs to accept. Dr. John Chisholm, chairman of the BMA's general practitioners committee said:
	"The profession has given a clear mandate for change. A large majority of general practitioners—eight out of ten—want the new contract to be introduced".
	Significantly, Dr. Chisholm continued:
	"While I am delighted by the overwhelmingly supportive vote in favour of the new contract, I am in no way complacent. The negotiations have been difficult and there are GPs who do not have confidence in parts of the new contract. The negotiating team is in no doubt what their concerns are and there is much work to be done during the implementation phase of the contract. This will begin immediately."
	Dr. Chisholm summed it up 100 per cent. accurately. A number of GPs have misgivings, and those who supported the contract despite their misgivings probably did so because they thought that it was important to resolve the issue. I hope that during the implementation of the contract, everyone will work together to seek to iron out any problems, concerns and difficulties that arise.
	I do not want to detain the House for long, but I should like to raise a number of matters with the Minister. If he catches Madam Deputy Speaker's eye and responds to my questions later in the debate, I shall be grateful; equally, given the time pressure on our proceedings, I shall fully understand if he thinks it better to write to me rather than using up time that other hon. Members could use to contribute to the debate.
	First, as the Minister's briefing and the amendments demonstrate, the proposals, like other proposals that we debated earlier, will involve considerable regulation-making powers. I suspect that I will get the same old answer, to the effect that those powers will be subject to the negative procedure rather than the affirmative, but I would appreciate it if the Minister confirmed that my assessment is right. I will not repeat the speech that I made a little earlier about the affirmative procedure, save to say that, as, sadly, the sadly was not here for my contribution, I would immodestly recommend for once that he read it tomorrow—[Interruption.] I am grateful to my hon. Friend the Member for Tatton (Mr. Osborne), who obviously enjoyed my speech and understood the wisdom of it, but I shall spare the House a repetition—the Minister can read it.
	The Minister has said that the measures before us will simplify the legislative base—despite the new delegated powers, the overall volume of delegated legislation after implementation will be less than it is now. I would welcome confirmation that that is the case, but I am intrigued to learn how regulation will be reduced. I am old enough to have heard Governments of all political persuasions claim that there will be less regulation, and that less regulation means better government. I am cynical about those claims because, when it comes to the crunch, they are never realised. I would appreciate the Minister's comments on that.
	I should now like to deal with one or two specific issues arising from new clause 26. Subsection (4) of proposed new section 16CC, as the Minister will know, specifies that a PCT or a local health board must
	"co-operate with any other such body in the discharge of their respective functions".
	The explanatory notes state that that subsection imposes a duty on PCTs and local health boards in Wales to co-operate with other bodies. If the provision is intended specifically to deal with cross-border co-operation, why has it been drafted so widely? Is it intended to cover other instances in which co-operation is required? If that is the case, can the Minister explain what those instances will be, and in what sort of situations he envisages a need for such co-operation? Finally, will he confirm that the provision will mean that English PCTs and Welsh bodies have a reciprocal duty to co-operate with one another?
	Turning to enhanced services, new clause 27 inserts a number of new sections into the National Health Service Act 1977. The Minister referred to the changes that the Government will make to that Act through their amendments. However, the explanatory notes state that under proposed new section 28Q, a general medical services contract is a contract for primary medical services, as specified in paragraph 2.8 of the new GMS contract. However, it may also include enhanced services on the boundary of primary and secondary care such as specialised services in areas like drug and alcohol misuse, sexual health and depression. Where the new GMS contract does not provide for enhanced services, will the Minister confirm how and by what mechanism those services will be available to patients? I am sure that he will agree that this is a matter of critical importance. From the outset, there must be no misunderstanding about how the Government envisage this part of the Bill working.
	On the question of pay, proposed new section 28T allows the Secretary of State or the Welsh Assembly to make directions regarding payments to be made under the new contract. Will those directions provide for the minimum income guarantee? Can the Minister confirm that the Government do not intend to place a time limit on the minimum practice guarantee? Again, if the Minister can give some more information on that point, it will go a long way towards satisfying our quest for knowledge and will send a message beyond this Chamber to those who may have some concerns or uncertainty about what is a very important matter and a crucial part of the contract.
	Finally, proposed new section 28T(3) states that the payments will be made
	"by reference to compliance with standards or the achievement of levels of performance".
	Will the Minister provide more detail about the standards and performance targets intended under the regulations?
	The Minister will be relieved to hear that I do not intend to reopen the debate pursued with such skill in our Opposition day debate yesterday by my right hon. and learned Friend the Member for Folkestone and Hythe (Mr. Howard), the shadow Chancellor, and by my hon. Friend the Member for Woodspring (Dr. Fox), the shadow Secretary of State for Health. I do not want to cause the Government embarrassment for a second day running, but I should be grateful if the Minister would expand on the question of targets.
	In his concluding remarks, the Minister said that he hoped that hon. Members on both sides of the House would accept the Government amendments and, in effect, the new GP contract. I assure him that the Opposition broadly accept the GP contract. I have no intention of asking Opposition Members to divide the House on this matter. However, I should be grateful if the Minister will provide me, when it is practicable and sensible to do so, with answers to my questions.

Evan Harris: I begin by offering my apologies to you, Madam Deputy Speaker, and to the Minister, for my slightly delayed arrival. There was a lobby of social services users—appropriately enough—from my county this afternoon. They are waiting for me to lodge a petition this evening, which I shall do if I am able to catch your eye when the time comes. I was detained with them, and I regret missing the beginning of the Minister's speech. However, I understand that, in the bit I missed, he set out in general terms the issues relating to the background of the new clauses.
	I am keen to speak to amendment (a), tabled in my name. The Minister began to deal with that, and the hon. Member for South Cambridgeshire (Mr. Lansley), in his perceptive style, also made a substantial part of the contribution that I was going to make. However, I also have a number of questions with which I hope that the Minister will deal, given the Committee style of our proceedings today. I should be grateful if he ensures that he is able to cover them. By way of advance notice, I can tell him that he will find some of the matters that I want to raise among the questions that I placed on the Order Paper yesterday. They were not selected for debate, but I am grateful that a starred amendment was selected, given its late submission.
	I share the gratitude expressed by the hon. Member for West Chelmsford (Mr. Burns) for the fact that we have some explanatory notes, even if we did not get much warning that they were coming and had little time to read them before the deadline for tabling amendments. As I said in respect of the programme motion, it is not very satisfactory that a large chunk of new clauses and amendments should be presented with so little time to consider them before the debate. Even so, like the hon. Gentleman, we must do what we can with what we are given.
	With regard to amendment (a), the Minister rightly recognised that it raises concerns about incentive payments in general terms. However, he—and the hon. Member for South Cambridgeshire—were both right to recognise that it relates specifically to incentive payments for vaccinations and immunisations, especially childhood immunisations.
	The problem is that, if the system works, it will be of questionable ethics. If it does not work, it will be unnecessary. The Minister has argued that, if GPs were not paid to meet a target, some people would not receive the vaccination that they needed, even after a consultation. Effectively, therefore, there is a third person in the consultation room with the doctor and the patient, or the patient's parents. That third person is the doctor's accountant.
	In general terms, I do not think that that is how a doctor-patient relationship should be conducted. It seems to me entirely wrong that GPs should entertain the notion that, if seven out of the next 10 patients do not end up with being immunised after their consultation, they—the GPs—will miss out on a significant amount of money. It is not an item of service payment, or a payment per immunisation, as the payment kicks in once a threshold is reached. If a doctor is on the cusp of achieving that incentive, the risk is that that factor will creep into the consultation.
	The Minister would consider that to be a success. Like me, he believes that immunisation, where clinically inappropriate and in the absence of contraindications, is a good thing. Even so, it is not appropriate for a GP's recommendation to be backed up—in force or in any other way—by the promise of payment for reaching a particular target. That is not the relationship of equipoise that ought to exist. Doctors and patients should not have these incentive payments and targets in mind.
	If the Minister is arguing that the system works and that doctors are right to chase payment in the consultations, that is not an ethical basis for giving treatment. If the system does not work—if it is not a relevant factor in increasing the number of immunisations—then what is the point in having it? Indeed, I would go further and state that not only is the system pointless, it is damaging. Even if a GP is not influenced by the equation that states that, to reach the threshold, he needs to get seven of the next 10 patients immunised, the perception that he is being influenced still exists. To a great extent, that will undermine the doctor-patient relationship.
	Informed patients—and patients in general—may well be concerned that their doctors will be influenced by the incentive payment. That is especially the case in an area such as immunisation, where the recommendation is being given not to a competent patient—that is a patient with capacity—or even to a Gillick-competent patient, but to a patient without capacity, whose parents must make a decision.
	That is an especially sensitive area. We are talking about treatments that are given to healthy people, and it is understandable that some parents may feel that an unnecessary intervention is being made in respect of a healthy child. It is always more difficult to see the need for such an intervention than for treatment for a person who is symptomatic.
	In addition, many parents and patients may be aware that they benefit from herd immunity and consider that they do not need the immunisation because they can rely on others. That is not an approach that I recommend, but it is a serious concern.

Andrew Lansley: Before the hon. Gentleman moves off this point, does he share my concern about the incentive payment mechanism? The mechanism is not specified in the contract, which states only that it will be the subject of further discussion and that exception reporting does not apply. Moreover, under the new contract, GP practices will be able to opt out from providing additional services, at a cost of just over £1,000 of the global sum. Does the hon. Gentleman agree that there is a risk that practices that are unhappy with the ethical position presented in the contract may simply choose to opt out of the arrangement? Would not that undermine our ability to deliver this additional service?

Evan Harris: Quite so. Immunisation levels are so marginal that we cannot run that risk. The Minister may say that he cannot run the risk of removing incentive payments, but I hope that he will give me some comfort by assuring us that if the system is pursued, it will be changed. There is less of an argument against having a threshold for the number of consultations, so that GPs will be incentivised to consult patients. However, if patients refuse or reject standard immunisation, even with no good clinical reason, that should not penalise the doctor. The Minister could achieve the improvement of access to immunisation that he wants and ensure that there is a proper call and recall system by setting incentive payments—if they have to happen—at a proportion of the eligible population receiving those consultations.
	In fact, that should be the default position and the Minister should have to justify his current position on two grounds. First, there should be clear evidence that a threshold for immunisation payments given works. It is not good enough to look at trends without having an adequate control group to determine what would happen over time if the threshold payment system did not apply. Indeed, the Minister might consider a test whereby in some parts of the country some practices did not operate an incentive scheme for immunisations given, so they would not be penalised when people without good clinical reasons refused immunisation. Simply to cite trends coincident with the introduction of incentive payments is the same sort of logic as he and I both reject when people cite increases in the incidence of autism at the time the MMR vaccine was introduced. If the test is not controlled, such arguments do not have a rational scientific basis. Where there is better evidence—as there was in that case—it should be cited. I urge the Government to show convincingly that there is evidence that the scheme works.
	Secondly, the Minister needs to show that he can overcome the ethical objection that I identified and the public relations problem—people who have lost confidence in the system—before he proceeds with the incentive scheme.
	In Committee, the Minister said that it would be unwise to try to amend these provisions because GPs had just come to an agreement, so any amendments would undermine that agreement. That cannot be right. First, it is the right of the House to make amendments to legislation. Secondly, GPs are still not happy about some aspects. As we know from the recent BMA meeting, incentive payments are one such matter. I should be grateful if the Minister provided some explanation and a defence of his position in response to those charges.
	I have a few more questions that relate to the Liberal Democrat amendments that were not selected. Can the Minister explain why subsection 28U (2) of the new clause states "may" rather than "must"? One would have thought that regulations were definitely needed to make provision for all the points listed under subsection (2). Indeed, a series of questions flows from that and we should try to deal with them if we had time.
	Subsection (3) refers to regulation of the circumstances in which a contractor or contractors
	"may decline to accept a person as such a patient; or . . . may terminate his or their responsibility for a patient".
	Will the Minister explain how that will work? Can he confirm whether the provisions are merely a translation of the existing arrangements? If so, he will know from representations made to him and from the health ombudsman's report that that is not satisfactory. Like many other Members, I certainly know of patients in my constituency who have been struck off their GP's list with no reason, even where—as is true in the majority of circumstances—there is no question that it would damage the patient's interests to know the reason.
	Often the reason is that the patient has made a complaint. The Minister knows that that is an unacceptable basis for striking off. He knows that the BMA guidelines sent out by family health services authorities, health authorities or whatever they are called nowadays make it clear that the practice is unacceptable. I have an example from my constituency. In a conciliation meeting, a GP told a patient that they should not have complained to their GP if they wanted to stay in the practice. That is unacceptable.
	The Minister has an opportunity to toughen up the regulations. There is an argument that the reasons for which patients can have their relationship with their GP terminated should be limited. That is not just on the ground of natural justice but because it can be so damaging for a patient to be treated in that way, especially when they do not receive a good reason or even any reason at all. Unfortunately, that is a problem in the culture—I speak as someone who has practised as a doctor. It is on the wane, but it still exists; GPs and other doctors still find it hard to adjust to having their treatments questioned. However, that is part and parcel of a modern NHS with empowered patients, and the regulations must keep pace.
	Will there be provision for an appeals process that is open and transparent? It should allow the patient to be reinstated in the practice without GPs automatically saying that they cannot possibly have the patient back because the termination process means that the GP-patient relationship is irrevocably broken. That is a circular argument and such a fallback position cannot be right. I should be grateful if the Minister explained his thinking about that.
	Subsection 28U (6) states that a GMS contract
	"must contain provision requiring the contractor or contractors to comply with any directions given by the appropriate authority"—
	which, as we know from reading the regulations, is the Secretary of State in England—
	"for the purposes of this section as to the drugs, medicines or other substances which may or may not be ordered for patients in the provision of medical services under the contract".
	At short notice, it is difficult for me to determine whether that is a brand new provision or a translation of existing provisions. Can the Minister clarify that point?

John Hutton: There is a risk that I might forget that point in my summing up. The provision is a continuation of the existing legislative arrangements; it is not new.

Evan Harris: I checked in the table provided by the Minister to determine whether that was the case. It states that the provision replaces schedules 10 and 11, which are, as we know from our debates on Sildenafil, infamous. Is the provision a direct translation? Sildenafil, or Viagra, probably offers a good example, although I do not want to go too far down that path.

Patrick Cormack: Why not?

Evan Harris: Because I know that other Members want to speak and I do not want to provoke Members into reopening that debate.
	Can the Minister tell us whether it would be a breach of contract, or a breach of the terms and conditions of a general practitioner under a GMS contract, for a GP providing primary care services under a GMS contract to prescribe something that the Secretary of State has put under schedules 10 or 11? At present, that is not a breach of terms and conditions because GPs can provide such drugs privately; indeed, they have to do so if they are not to be out of pocket, because they are not reimbursed. In effect, that is rationing. I do not object to rationing itself, but it should be explicit. Normally, if rationing is an issue, it is possible for prescribing freedoms not to be limited and the GP has to explain, within the reimbursement process, what is going on. There may be exceptions, where reimbursement for such a prescription is appropriate, but the blanket provision in the regulations that the subsection may herald could go further than schedules 10 and 11.
	I accept that the matter is technical and that the Minister may not be able to address it at present. If we were in Committee, I should ask him to write to me before Report. However, perhaps he can address that point, as several practitioners have raised it.
	Proposed section 28R deals with the power to set out in regulations the primary medical services that a GP must provide under a GMS contract. In the third column—headed "replaces"—of that very useful table in the explanatory notes, the Minister explains that proposed new section 28R will replace a description in section 29 of the National Health Service Act 1977. The explanatory notes do not specify any provision; they refer to the agreement on essential services in paragraph 2.8. However, among other things, section 29 of the 1977 Act states:
	"Regulations may provide for . . . securing that the arrangements will be such that all persons availing themselves of those services will receive adequate personal care and attendance, and the regulations shall include provision".
	It goes on to provide further specifications. 7 pm
	New clause 26 has been written in very vague terms, so it waters down the obligation in the Bill to ensure that patients can refer to something when protesting that the essential services are insufficient to fall within the remit of the primary legislation. I should be grateful to the Minister if he reassured me about the absence of any description in primary legislation in respect of what must be provided to meet reasonable needs.
	Why are such things not still defined in the new arrangements? If they were defined, future negotiations could allow something that patients have a right to expect beyond the current definition of adequate personal care and attendance to be moved from paragraph 2.8 of the GP contract, which deals with essential services. Does the Minister accept that removing section 29 of the 1977 Act without replacing it with a similar duty represents a dilution, unless I have missed something? That brings me to the Government's amendments on primary dental contracts.

Patrick Cormack: The hon. Gentleman has been speaking for 20 minutes now.

Evan Harris: I have got amendments in this group, and it is reasonable to speak for 20 minutes. The hon. Gentleman made the point earlier that we did not have enough time in Committee. I will ensure that I end my speech shortly, so that he has a chance to speak, but I have a specific question on the Government's amendment on dentistry.
	The Minister has chosen to accept some of the arguments made in Committee about the fact that the definitions in clause 161 were inadequate. He now proposes to delete from clause 161 the words
	"it is reasonable to do so"
	and insert,
	"necessary to meet all reasonable requirements, exercise its powers so as to."
	I should be grateful to the Minister if he clarified whether that addresses the point made in Committee about the language used. Is the word "necessary" the significant addition? If it is, I should like to thank him for making that concession. I should like him to deal with the description of services set out in clause 161 for primary dental services and identify—I may have missed it—where the similar general description of the reasonable requirements that it is felt necessary to meet for primary medical services appears in the new provisions.
	My last point relates to proposed new section 28U(3), where the Government's description refers to a power to make regulations setting out the relationship between contractors and their patients. Those relationships are covered in chapter 6 of the NHS Confederation/General Practitioners Committee agreement. The legislation refers to issues relating to termination of the relationship between patients and GPs. I have mentioned patients being the struck off the list. However, I am a bit concerned whether chapter 6 of that agreement is the way by which the proposals that the Government floated in the Labour party about a contract between the patient and the GP may be enforced.
	I should like the Minister to clarify whether chapter 6 of that agreement could be used, if amended in future, to make patients agree to stop smoking, stop eating or start exercising before they can continue to get services. Perhaps the Minister will welcome the opportunity to put that idea to rest, because a number of people have read into the consultation that the Minister is undertaking in the Labour party that that may be the result.
	We recognise that, overall, the contract represents a good deal for GPs, especially in financial and work load terms, but that is not the same as saying that it represents a good deal for patients because, especially in respect of the number of hours that GPs have to work, there is a zero sum gain. If GP work load is reduced, the services that patients can get from their GPs at a one-stop shop, holistically, are inevitably reduced.
	The Government say that GPs will no longer have to provide out-of-hours services if they choose not to do so. Indeed, they will be paid for their other services even if they choose to drop that responsibility. GPs will be paid more, even if they do less, so patients will get less of a service from their own GPs. I understand that there are not enough GPs and that there are not enough hours in the day for GPs, but I hope that the Government will accept that patients would not have voted for the new contract, even if GPs thought that accepting it was the only thing that would allow them to cope with their work load. Until there is a significant number of new GPs, patients and GPs will not benefit from the new contract.

Patrick Cormack: I will certainly be briefer than the hon. Member for Oxford, West and Abingdon (Dr. Harris). I do not dispute for a moment that all the points that he raised were very pertinent and should be addressed. Again, the terrible time constraints under which we have to debate this very important Bill have been underlined.
	I regard the Minister as a very honourable and extremely decent man, and I know that he has the interests of patients very much at heart. That is not in dispute, but I am very concerned about one aspect of the contract in particular. I touched on it in an intervention, as did the hon. Member for Oxford, West and Abingdon towards the end of his speech. What concerns me is the service that patients will receive.
	I fully understand the need for the contract. I completely support my hon. Friend the Member for West Chelmsford (Mr. Burns), who spoke eloquently from the Opposition Front Bench. He said that he supported the Minister and that he would not seek to divide the House. I am glad about that, and I certainly would not wish to do so. I hope that no one will do so on this issue. However, while it is possible to go through life without going into hospital, it is virtually impossible to go through life without needing the services of a doctor, so we are dealing with a part of the Bill that affects every man, woman and child in this country. I believe in the NHS. If we are to have a national health service worthy of the 21st century, it is crucial that the services provided by GPs—family doctors—are of the highest possible excellence.
	I am surprised that no Labour Back Bencher is present for this important debate, but I do not wish to make too much of that. Let me just say that, when the right hon. Gentleman answered my questions most courteously, he did so with a disturbing imprecision. When I asked him about the relationship between the patient and the practice and where the PCT kicked in, he did not give me a terribly clear answer. It is crucial that the patient looks to the practice with which the patient is registered for all services, both those within and without hours.
	If there is a contractual arrangement that the practice does not provide out-of-hours services, that should be fixed up between the PCT and the practice, so that the patient has absolutely clear information. We have to remember that, although there are some hoaxers and malingerers, most patients who need a doctor out of hours are genuine people who are alarmed and need a service. The last thing that they want is a plethora of telephone numbers or a sheaf of papers. Those people are often elderly. They are sometimes old, distressed and even confused. A doctor is needed for the husband, the wife or the child in the middle of the night, but how is that doctor obtained? I should be most grateful to the Minister if he addressed that point and told us how such things will work.
	I have a rural constituency—not as large as some of my colleagues' rural constituencies, but quite large. I have had experience of patients who are registered with practices that rely for virtually all their out-of-hours services on agencies. If the patient gets a doctor who has no idea of the geography of the area, who takes a long time to reach them, who does not know the patient and knows nothing of his or her medical history, it is hardly reassuring. Any agency that provides an out-of-hours service for a practice should have all their cars equipped with satellite navigation, which is simple these days—I have it myself, and I find it helpful when I am driving around an area that I do not know. It would be most reassuring if when people made a telephone call they knew that the doctor would arrive on their doorstep in pretty sharp time.
	This aspect of the contract worries me. It is underlined by something that was said to me by the wife of a GP in my constituency a little while ago. I was shocked—perhaps I am too old-fashioned—that she said, "Of course, medicine is not a vocation any more. It's just a job." I am naive and idealistic enough to believe that the element of vocation is terribly important and should still exist. Of course doctors deserve private lives as much as anybody else, and of course they have great pressures on them—many of them work in practices whose lists contain thousands of names. Of course it is incumbent on us to ensure that they have a contract that allows them to have decent private time and decent private lives. Nobody makes a man or woman become a doctor, however, and the element of vocation is important. When somebody has a sense of vocation, as most of us in this place do, hours sometimes have to be forgotten.
	I trust that the Minister's answer will reassure me satisfactorily—because this would also reassure my constituents—that however the new arrangement works, the patient will still feel registered with a practice, that if illness strikes in the dark hours of a winter's night a doctor can be summoned, will be summoned and will appear in reasonable time, and that the quality of care will be commensurate with that given by the doctor who regularly sees the patient at the surgery. That is what I and my constituents are concerned about, and I am sure that the same applies to the constituents of every Member in every part of the House.
	I thank the Minister for what he has done. I appreciate the information that he got to us—albeit a little late, but that was not his fault—and, I have absolutely no doubt about his personal integrity or desire to ensure that the quality of medicine is the highest possible. I have these worries, however, and I hope that he can reassure me. When he winds up this all-too-brief debate, I hope that he will be able to give me that reassurance, so that I can pass it on to my constituents.

Andrew Lansley: I am grateful for the opportunity to contribute to this short debate on an important subject. I feel confident that the Minister will have a few minutes in which to reply fully to the points raised. I thought that my hon. Friend the Member for West Chelmsford (Mr. Burns) was generous to the Minister in contemplating that he might respond to some of the questions asked subsequently. It seems to me that the Minister has lived with the subject of the general medical services contract for some time, and I would be surprised were we to raise issues to which it was not within his competence to reply. I hope that he will reply in substance to our points.
	My purpose is not to speak about the construction of the legislation and the new clauses and amendments, but about what lies beneath them: the new contract and how that it is to be framed. The debate gives us an opportunity for such discussion. It does not depend on the documents sent to us by the Minister, which I received on Friday in the House, but on the "Investing in General Practice" document, which, as the Minister rightly told us, was published in February. There has therefore been scope to think about these issues, but none to raise them. That is why I am disappointed that we did not get an opportunity prior to this to do so. It seems rather last-minute.
	Let me run through my points, some of which have already been mentioned. The first was rightly raised by my hon. Friend the Member for South Staffordshire (Sir Patrick Cormack). Much as we might be putting into legislative effect the framework for the contract negotiated between the NHS Confederation on the one hand and the GPs committee of the British Medical Association on the other, we are the guardians of the interests of the public, and, in that respect, of the interests of patients. I hope that my remarks will not be interpreted wrongly—both those organisations have the interests of patients at heart, too, but the final responsibility rests with us.
	My hon. Friend expressed the concerns that have been raised in the right way, and I do not want to add to them, except to say that this is not simply about out-of-hours cover. The out-of-hours issue is terribly important, and I know that the Government will have thought long and hard about the extent to which practices can opt out of it; offering a timetable of 31 December 2004 for opting out is bold. I hope, however, that we will not find in the latter stages of next year or the early part of 2005 that, in practice, primary care organisations are seeking to provide out-of-hours cover for a high proportion of practices that are not willing to take it up, or a high proportion in rural areas in particular that are not willing to take it up, and that the alternative service models that are being developed simply cannot cope. I hope that we do not arrive at that, and I am sure that the Minister will give us some comfort that he feels confident about the scale—and the relative modesty of the scale—of opting out by practices, as it will be very difficult if it is much more than Ministers anticipate.
	The second point, particularly in relation to rural areas, is the patient services guarantee. The patient services guarantee to which the Minister referred, I understand, is a guarantee for the primary care organisation to have a continuing responsibility for the provision of services under the existing contract. It is not, however, a guarantee that those services will be provided by the existing practice, because, of course, the practice in question has the ability to opt out of additional services. Therefore—this is particularly relevant in rural areas—if the service is being provided by other practices, other primary care providers or by the primary care organisation itself, provision may be in a number of different places. A considerable difference of substance exists between receiving one's essential services from a single practice, and, in respect of additional services, perhaps having to go to a more remote town or city to access a range of different services. In relation to provision for rurality, sparsity and special allocations of funds to reflect the costs of travel and the like in rural areas, I hope that the Minister will think hard and keep a weather eye on the extent to which the patient services guarantee leads to deterioration in the level of service or access to service for patients, whether in rural areas or anywhere else, and that he will be willing to intervene if necessary to boost some of the enhancements to practices, particularly in rural areas, if it proves that the incentives are not sufficient.
	I want to echo two points made by the hon. Member for Oxford, West and Abingdon (Dr. Harris). I have been concerned about a case in my constituency, as other Members will be, involving the circumstances under which practices have the right to remove patients from their lists. He referred to that in the text of new clauses, but, of course, it reflects paragraph 6.29 in the contract. Of course, we know that patients may be removed if they are violent and that primary care organisations have to take responsibility in such circumstances. Paragraph 6.29 clearly says:
	"Removal from a list will follow a transparent process that normally would include a warning to the patient before removal".
	That is quite right. The subsequent sentence is less clear and gives rise to a specific concern. It says:
	"When a patient is removed, practices will be required to give specific reasons to the patient as to why the removal has occurred, though it is accepted that, in certain specific circumstances, a statement to the effect that the relationship between the patient and the practice has irrevocably broken down will suffice."
	What are the "certain specific circumstances" in which such a situation could occur? I suspect that they applied when my constituent was removed from a list. That process affected not only him but his wife and family because the practice's decision that the relationship with him had broken down meant that the whole family were effectively treated as though their relationship had broken down. The family live in a rural area, so the distance that they must travel to an alternative practice is substantial. My constituent believed that there was no underlying reason behind his removal from the practice. I suspect that it happened because he made a complaint, as the hon. Member for Oxford, West and Abingdon mentioned. That should not be sufficient to allow removal because there should be a formal and transparent process. I want to know the specific circumstances in which patients may be removed.
	On immunisation, I have said that it is surprising that exception reporting for informed dissent will not be applied to the target payments. I have a technical question. Amendment No. 299 will disapply section 53 of the National Health Service Act 1977 under which every practitioner who is under contract to provide personal medical services should be enabled to offer child vaccination and immunisation services. Will the Minister explain why that provision must be removed?
	I want to make a further point about the structure of the contract itself, although perhaps I should have raised it with the British Medical Association because it worries about such things. I earlier expressed concern about the extent to which information technology systems in the NHS are being centralised and said that the responsiveness of the IT system to individual customers was being removed. I fear that the same will be true of information management and technology systems for practices. The BMA and general practitioners might feel comfortable at the moment that they will enjoy the benefits of centralised standardisation, purchasing and funding for the provision of IT systems and the telecommunications to support that, but GPs will not be the customers. I wonder whether the BMA is entirely confident that GP practices will be able to exercise the same control over their service providers that they do at present. They currently spend their own money and obtain their systems from a range of competing providers that meet the necessary protocols of standardisation—the systems need to be able to talk to each other. There should be a customer-contractor relationship between a practice and its service provider, but that will not exist in future.
	I am worried by paragraph 5.16 of the contract. It is an obtuse, yet important, part of the structure of remuneration and it relates to the adjustment of the list size for list inflation. Up until now, the registered population has tended to exceed the population estimates of the Office for National Statistics. In future, primary care organisations will rely on new census population estimates. It will come as no surprise to the Minister that there are places throughout the country—the most prominent are Westminster and central London, but the same can be said of the city of Cambridge—in which there are significant discrepancies between population estimates from the 2001 census and the figures anticipated. If those statistics affect the allocation of resources to primary care organisations and their practices under the contract, I am worried that structural problems with census population data will lead to problems with the contract. I hope that the Minister understands that caveats might need to be entered against that.
	I asked the Minister earlier about order-making powers. He said that the negative procedure would be used; I assume that he meant in all cases. I imagine that many orders that arise from the Bill would not need to be considered using the affirmative procedure, but I urge the Government and those in another place who care deeply about the structure of legislation to look hard at Government new clause 26. It contains order-making powers to prescribe services that
	"are, or are not, to be regarded as primary medical services"
	and to define how they should be delivered. That is one of the central issues behind the new structure of contracts for personal medical services and general medical services. It would not be excessive for Ministers to give an undertaking that such orders at least would be considered under affirmative resolution. It would be undesirable if Opposition parties had to pray against orders so that something so central to the contract's structure could be debated.

John Hutton: I warmly thank hon. Members who contributed to the debate for their remarks. I am grateful to the official Opposition and the hon. Member for Oxford, West and Abingdon (Dr. Harris) for their general support for the new contract. However, I am afraid that I shall lower the tone by saying that the hon. Gentleman's reluctance to express anything like enthusiasm for the decision taken by 80 per cent. of GPs to embrace the new contract was typically curmudgeonly. Although it has nothing to do with the amendments, it is not the case that patients would not have voted for the new contract, although neither the hon. Gentleman nor I can prove that.
	The new contract represents a significant development for primary care that will allow us to provide a better range of primary care services than at present. The arrangement is good for GPs and everyone who works in primary care but it has been exclusively driven by our one simple desire to improve the range of primary care services available to the people of this country. I think that people would overwhelmingly vote for that if they were given the opportunity, but I hope that the hon. Gentleman understands from our previous debates that we do not suggest extending the democratic franchise quite that far—we have enough on our plate with NHS foundation trusts.
	It is important to bear in mind one or two basic facts and figures about primary care. Much of the debate has been focused on the importance of out-of-hours services, and I agree that they are central to many people's perception of the comprehensive nature of NHS services. GPs and practice staff in primary care deal with about 250 million consultations each year, and 90 per cent. of all patient journeys in the NHS begin and end in a family doctor's surgery. The work done in primary care will certainly be central to the success of the national health service well into the future. I do not question the commitment of the hon. Member for South Staffordshire (Sir Patrick Cormack) to the national health service because he, like me, wants it to be a success. It is important that the issues raised by the hon. Members for South Staffordshire, for South Cambridgeshire (Mr. Lansley) and for Oxford, West and Abingdon are addressed properly as we move toward implementing the new agreement.
	There is no doubt that there are risks. Perhaps the most difficult aspects of the agreement were the out-of-hours provisions. I know from my work as a constituency MP that our constituents place a high premium on around-the-clock access to a GP, 24 hours a day, seven days a week. It is a defining characteristic of our primary care services. I can give the hon. Member for South Staffordshire the assurances he seeks: we will implement the agreement to ensure that there is no loss of access to out-of-hours services. That is intrinsic in the agreement that we reached with the NHS Confederation and the British Medical Association. They recognise the importance of the service, too.
	I have had the benefit of talking to many GPs about the new contract. Without exception, they all want the out-of-hours services, and the quality of those services, maintained because doctors care deeply about the well-being of their patients. They will not accept for a second a diminution in the quality of out-of-hours services. I am sorry if my answer was not to the hon. Gentleman's satisfaction, but it will be the responsibility of primary care trusts, in discussions with their local practices, to finalise, over the course of the next year or so, the arrangements that will need to be put in place locally to provide comprehensive out-of-hours services. That will include a proper setting of standards to be met. The arrangements governing accessibility of the service, who comes out to deal with a call and how quickly he or she arrives are important and will need to be put in place. It is a big job, but we have worked actively with primary care trusts to ensure that the hon. Gentleman's constituents, like mine, are not put at risk or disadvantaged. I am sorry if my original answers were not precise enough, but I assure him that that is how we intend to proceed. We would not accept anything less.
	The hon. Member for West Chelmsford (Mr. Burns) mentioned the technical aspects and asked me to give an example of how we are reducing the burden or the volume of secondary legislation. I gave him one example and am happy to give him others in due course. He asked how enhanced services will be provided if not through GMS or PMS. They can be provided through the additional third route of directly commissioned PCT services and the services of additional providers can also be used. He also asked whether the minimum practice income guarantee would be covered by directions under proposed new section 28T. It will be. The minimum income guarantee will continue beyond 2006. It is not time limited.
	On subsection (4) of proposed new section 16CC, I can assure the hon. Gentleman that the duties are reciprocal. It is not one-way traffic. The duties are broadly designed to deal with some of the cross-border issues that he mentioned, including the need to move to single commissioning of primary care services in those areas if possible.
	The hon. Member for Oxford, West and Abingdon asked a number of questions. I am afraid that I shall have to write to him. I hope that he does not mind. He did invite me to go down that path and I intend to take advantage of that get-out. He kept referring to "U2", which is one of my favourite bands. I did not realise we were debating that today, and I am happy to discuss it with him another time.
	The hon. Member for South Cambridgeshire asked pertinent questions. Given the time left, I shall have to write to him with further details. I am more than happy to meet hon. Members who contributed to the debate to discuss primary care services at any time in the future. I am also happy to arrange for them to be briefed by my officials, if they would find that helpful. The hon. Gentleman referred to the difficult issue of removing patients from practice lists and how we could deal with that. He is right to refer to sections of the February agreement that attempt to deal with the problem. We intend to use the regulatory powers to set out some of those issues in secondary legislation. It is not an entirely satisfactory state of affairs for any patient to be declined registration or to be removed from a practice. As the hon. Member for Oxford, West and Abingdon said, professional practice guidelines have been set out and we hope people will follow them.
	The debate has been helpful. I am grateful for the support expressed for the Government new clauses. I look forward to discussing related issues in due course.
	It being six and a half hours after the commencement of proceedings on the programme motion, Mr. Deputy Speaker proceeded to put forthwith the Questions necessary for the disposal of business to be concluded at that hour, pursuant to Order [this day].
	Question put and agreed to.
	Clause read a Second time, and added to the Bill.

New Clause 27
	 — 
	General medical services contracts

'(1) In the 1977 Act, after section 28P (as inserted by section 163 above) insert—
	"General medical services contracts
	28Q General medical services contracts: introductory
	(1) A Primary Care Trust or Local Health Board may enter into a contract under which primary medical services are provided in accordance with the following provisions of this Part.
	(2) A contract under this section is called in this Act a "general medical services contract".
	(3) Subject to any provision made by or under this Part, a general medical services contract may make such provision as may be agreed between the Primary Care Trust or Local Health Board and the contractor or contractors in relation to—
	(a) the services to be provided under the contract,
	(b) remuneration under the contract, and
	(c) any other matters.
	(4) The services to be provided under a general medical services contract may include—
	(a) services which are not primary medical services;
	(b) services to be provided outside the area of the Primary Care Trust or Local Health Board.
	(5) In this Part, "contractor", in relation to a general medical services contract, means any person entering into the contract with the Primary Care Trust or Local Health Board.
	28R Requirement to provide certain primary medical services
	(1) A general medical services contract must require the contractor or contractors to provide, for his or their patients, primary medical services of such descriptions as may be prescribed.
	(2) Regulations under subsection (1) may in particular describe services by reference to the manner or circumstances in which they are provided.
	28S Persons eligible to enter into GMS contracts
	(1) A Primary Care Trust or Local Health Board may, subject to such conditions as may be prescribed, enter into a general medical services contract with—
	(a) a medical practitioner;
	(b) two or more individuals practising in partnership where the conditions in subsection (2) are satisfied; or
	(c) a company limited by shares where the conditions in subsection (3) are satisfied.
	(2) The conditions referred to in subsection (1)(b) in relation to a partnership are that—
	(a) at least one partner is a medical practitioner; and
	(b) any partner who is not a medical practitioner is either—
	(i) an NHS employee;
	(ii) a section 28C employee or a section 17C employee;
	(iii) a health care professional who is engaged in the provision of services under this Act; or
	(iv) an individual who is providing services under a general medical services contract or a general dental services contract or in accordance with section 28C arrangements or arrangements under section 17C of the National Health Service (Scotland) Act 1978, or has so provided them within such period as may be prescribed.
	(3) The conditions referred to in subsection (1)(c) in relation to a company are that—
	(a) at least one share in the company is legally and beneficially owned by a medical practitioner; and
	(b) any share which is not so owned is legally and beneficially owned by a person referred to in subsection (2)(b)(i) to (iv).
	(4) Regulations may make provision as to the effect, in relation to a general medical services contract entered into by individuals practising in partnership, of a change in the membership of the partnership.
	(5) In this section—
	"health care professional" has the same meaning as in section 28M above;
	"NHS employee", "section 28C employee" and "section 17C employee" have the same meanings as in section 28D above.
	28T GMS contracts: payments
	(1) The appropriate authority may give directions as to payments to be made under general medical services contracts.
	(2) A general medical services contract must require payments to be made under the contract in accordance with directions for the time being in force under this section.
	(3) Without prejudice to the generality of the power under subsection (1), directions under that subsection may—
	(a) provide for payments to be made by reference to compliance with standards or the achievement of levels of performance;
	(b) provide for payments to be made by reference to—
	(i) any scheme or scale specified in the direction; or
	(ii) a determination made by any person in accordance with factors specified in the direction;
	(c) provide for the making of payments in respect of individual practitioners;
	(d) provide that the whole or any part of a payment is subject to conditions (and may provide that payments are payable by a Primary Care Trust or Local Health Board only if it is satisfied as to certain conditions);
	(e) make provision having effect from a date before the date of the direction, provided that, having regard to the direction as a whole, the provision is not detrimental to the persons to whose remuneration it relates.
	(4) Before giving a direction under subsection (1), the appropriate authority—
	(a) must consult any body appearing to the authority to be representative of persons to whose remuneration the direction would relate, and
	(b) may consult such other persons as the authority thinks appropriate.
	(5) Section 18(1) and (3)(b) apply in relation to directions under this section.
	(6) References in this section to payments include fees, allowances, reimbursements, loans and repayments.
	(7) In this section "appropriate authority" means—
	(a) the Secretary of State, in relation to a contract made by a Primary Care Trust;
	(b) the National Assembly for Wales, in relation to a contract made by a Local Health Board.
	28U GMS contracts: other required terms
	(1) A general medical services contract must contain such provision as may be prescribed (in addition to the provision required by the preceding provisions of this Part).
	(2) Regulations under subsection (1) may in particular make provision as to—
	(a) the manner in which, and standards to which, services are to be provided;
	(b) the persons who perform services;
	(c) the persons to whom services are to be provided;
	(d) the right of patients to choose the persons from whom they are to receive services;
	(e) the variation of contract terms (other than terms required by or under this Part);
	(f) rights of entry and inspection (including inspection of clinical records and other documents);
	(g) the circumstances in which, and the manner in which, the contract may be terminated;
	(h) enforcement;
	(i) the adjudication of disputes.
	(3) Regulations making provision under subsection (2)(c) may make provision as to the circumstances in which a contractor or contractors—
	(a) must or may accept a person as a patient to whom services are provided under the contract; or
	(b) may decline to accept a person as such a patient; or
	(c) may terminate his or their responsibility for a patient.
	(4) Regulations under subsection (2)(e) may—
	(a) make provision as to the circumstances in which a Primary Care Trust or Local Health Board may impose a variation of contract terms;
	(b) make provision suspending or terminating any duty under the contract to provide services of a prescribed description.
	(5) Regulations making provision of the kind described in subsection (4)(b) may prescribe services by reference to the manner or circumstances in which they are provided.
	(6) A general medical services contract must contain provision requiring the contractor or contractors to comply with any directions given by the appropriate authority for the purposes of this section as to the drugs, medicines or other substances which may or may not be ordered for patients in the provision of medical services under the contract.
	(7) Section 18(1) and (3)(b) apply in relation to directions under subsection (6).
	(8) In subsection (6) "appropriate authority" has the same meaning as in section 28T above.
	28V GMS contracts: disputes and enforcement
	(1) Regulations may make provision for the resolution of disputes as to the terms of a proposed general medical services contract.
	(2) Regulations under subsection (1) may make provision—
	(a) for the referral of the terms of the proposed contract to the Secretary of State or National Assembly for Wales; and
	(b) for the Secretary of State or Assembly, or a person appointed by him or it, to determine the terms on which the contract may be entered into.
	(3) Regulations may make provision for a person or persons entering into a general medical services contract to be regarded as a health service body for any purposes of section 4 of the National Health Service and Community Care Act 1990, in circumstances where he or they so elect.
	(4) Regulations under subsection (3) may include provision as to the application of section 4 of that Act in cases where—
	(a) persons practising in partnership elect to become a health service body; and
	(b) there is a change in the membership of the partnership.
	(5) Where—
	(a) by virtue of regulations under subsection (3), subsection (7) of section 4 of that Act applies in relation to a general medical services contract, and
	(b) a direction as to payments is made under that subsection in relation to the contract,
	the direction is to be enforceable in a county court (if the court so orders) as if it were a judgment or order of that court."
	(2) Sections 29 to 34A of the 1977 Act (arrangements for general medical services) shall cease to have effect.'—[Mr. Hutton.]
	Brought up, read the First and Second time, and added to the Bill.

New Clause 28
	 — 
	General Medical Services: Transitional

'(1) The appropriate authority shall by order make transitional provision in respect of persons who, immediately before the coming into force of section (general medical services contracts), are providing services under section 29 of the 1977 Act (general medical services).
	(2) An order under this section may provide that, in such circumstances as the order may prescribe, a Primary Care Trust or Local Health Board must, if any such person so wishes, enter into a general medical services contract with him; and the order may make provision as to the terms of any such contract.
	(3) An order under this section may provide that, in such circumstances as the order may prescribe, a Primary Care Trust or Local Health Board must, if any such person so wishes, enter into a contract with him, containing such terms as the order may specify, for the provision of medical services.
	(4) An order under this section may make provision for the resolution of disputes in relation to any contract entered into, or proposed to be entered into, under subsection (2) or (3), including provision for the determination of disputes by the appropriate authority or a person appointed by the authority.
	(5) An order under this section may make provision in respect of a period beginning before the coming into force of the provision (or of section (general medical services contracts)), provided that the provision is not as a whole detrimental to the remuneration of the persons to whom it relates.
	(6) In this section—
	"appropriate authority" means—
	(a) the Secretary of State, in relation to England; and
	(b) the Assembly, in relation to Wales;
	"general medical services contract" means a contract under section 28Q of the 1977 Act (as inserted by section (general medical services contracts))'.—[Mr. Hutton.]
	Brought up, read the First and Second time, and added to the Bill.

New Clause 29
	 — 
	Abolition of Pilot Schemes

'(1) Part 1 of the National Health Service (Primary Care) Act 1997 (c.46) (power to make pilot schemes for the provision of personal medical and dental services) shall cease to have effect.
	(2) This section extends to England and Wales only.'.—[Mr. Hutton.]
	Brought up, read the First and Second time, and added to the Bill.

Clause 161
	 — 
	Provision of Primary Dental Services

Amendments made: No. 270, in page 78, line 26, leave out
	'it reasonable to do so,'
	and insert
	'necessary to meet all reasonable requirements, exercise its powers so as to'.
	No. 271, in page 78, line 28, leave out
	'For the purposes of this section'.
	No. 272, in page 78, line 30, at end insert
	'(whether within or outside its area)'.
	No. 273, in page 78, line 33, leave out 'section' and insert 'Part'.
	No. 274, in page 78, line 36, leave out 'under this section' and insert
	'relating to the provision of primary dental services under this Part'.—[Mr. Hutton.]

Clause 163
	 — 
	General Dental Services Contracts

Amendments made: No. 275, in page 80, line 29, after 'contract', insert
	'or a general medical services contract'.
	No. 276, in page 81, line 1, leave out from 'employee"' to end of line 3.
	No. 277, in page 82, line 10, at end insert—
	'( ) the right of patients to choose the persons from whom they are to receive services;'.—[Mr. Hutton.]

Clause 165
	 — 
	Arrangements Under Section 28C of the 1977 Act

Amendments made: No. 278, in page 83, line 32, leave out from 'for' to end of line 43 and insert
	'paragraphs (b) and (c) substitute—
	"(b) a medical practitioner who meets the prescribed conditions;
	(ba) a dental practitioner who meets the prescribed conditions;
	(bb) a health care professional who meets the prescribed conditions;
	(bc) an individual who is providing services—
	(i) under a general medical services contract or general dental services contract;
	(ii) in accordance with section 28C arrangements or section 17C arrangements;
	or has so provided them within such period as may be prescribed;".'.
	No. 279, in page 84, line 3, leave out '(c)(iii)' and insert '(bc)'.
	No. 280, in page 84, line 10, leave out from 'subsection,' to end of line 23 and insert
	'for the definition of "NHS employee" substitute—
	""NHS employee" means an individual who, in connection with the provision of services in the health service in England and Wales, Scotland or Northern Ireland, is employed by—
	(a) an NHS trust, an NHS foundation trust or (in Northern Ireland) a Health and Social Services Trust;
	(b) a Primary Care Trust or Local Health Board;
	(c) an individual who is providing services under a general medical services contract or a general dental services contract;
	(d) a medical practitioner whose name is included in a list kept under the 1978 Act which is equivalent to a list maintained under section 28W below;
	(e) a dental practitioner whose name is included in a list prepared in accordance with regulations made under section 25(2)(a) of the 1978 Act;
	(f) a medical practitioner whose name is included in a list kept under article 56 of the Health and Personal Social Services (Northern Ireland) Order 1972 (1972 No. 1256 (N.I.14));
	(g) a dental practitioner whose name is included in a list kept under article 61 of that Order;".'.
	No. 281, in page 84, line 30, after 'arrangements;', insert—
	'(cb) provide for the circumstances in which a person providing primary medical services under section 28C arrangements—
	(i) must or may accept a person as a patient to whom such services are so provided;
	(ii) may decline to accept a person as such a patient;
	(iii) may terminate his responsibility for a patient;
	(cc) make provision as to the right of patients to choose the persons from whom they are to receive services;".'.
	No. 282, in page 84, line 39, at end insert—
	'( ) In that section, after subsection (3B) (as inserted by subsection (8) above), insert—
	"(3C) The regulations may also include provision requiring a Primary Care Trust or Local Health Board, in prescribed circumstances and subject to prescribed conditions, to enter into a general medical services contract or general dental services contract on prescribed terms with any person providing services under section 28C arrangements who so requests.".'.
	No. 283, in page 84, line 39, at end insert—
	'( ) In that Act, sections 28F (choice of medical practitioner), 28G (choice of dental practitioner) and 28H (immunisation) shall cease to have effect.' —[Mr. Hutton.]

Clause 166
	 — 
	Persons Performing Primary Dental Services

Amendments made: No. 284, in page 84, line 41, leave out '28P' and insert '28V'.
	No. 285, in page 84, line 41, leave out
	'163' and insert (general medical services contracts)'.
	No. 286, in page 84, line 42, leave out '28Q' and insert '28W'.
	No. 287, in page 84, line 42, after 'primary', insert 'medical and'.
	No. 288, in page 84, line 42, at end insert—
	'( ) Regulations may provide that a health care professional of a prescribed description may not perform any primary medical service for which a Primary Care Trust or Local Health Board is responsible unless he is included in a list maintained under the regulations by a Primary Care Trust or Local Health Board.'.
	No. 289, in page 85, line 8, at end insert 'medical or'
	No. 290, in page 86, line 9, after 'State', insert
	'or the National Assembly for Wales'
	No. 291, in page 86, line 10, after 'State', insert
	'or the National Assembly for Wales'—[Mr. Hutton.]

Clause 167
	 — 
	Assistance and Support

Amendments made: No. 292, in page 86, line 16, leave out '28Q' and insert '28W'.
	No. 293, in page 86, line 17, leave out '28R' and insert '28X'.
	No. 294, in page 86, line 20, after 'provide', insert 'primary medical services or'.
	No. 295, in page 86, line 21, after 'under', insert
	'a general medical services contract or'.—[Mr. Hutton.]

Clause 169
	 — 
	Special Health Authorities

Amendment made: No. 296, in page 86, line 31, leave out subsection (1).—[Mr. Hutton.]

Clause 170
	 — 
	Charges for Dental Services

Amendments made: No. 297, in page 87, line 40, leave out from 'Act' to end of line 42.
	No. 298, in page 89, line 21, at end insert—
	'(3) In respect of any period after the coming into force of this section but before the coming into force of section (abolition of pilot schemes), section 79(5)(b) of the 1977 Act (as inserted by subsection (1) above) shall have effect as if it included a reference to the supply of dentures and other dental appliances in accordance with a pilot scheme under Part 1 of the National Health Service (Primary Care) Act 1997 (c.46).'.—[Mr. Hutton.]

Schedule 10
	 — 
	Part 4: Minor and Consequential Amendments

Amendment made: No. 299, in page 134, line 3, leave out from beginning to end of line 28 on page 145 and insert—
	'National Health Service (Amendment) Act 1949 (c.93)
	1 (1) The National Health Service (Amendment) Act 1949 (which is spent in relation to England and Wales) shall cease to have effect.
	(2) This paragraph extends to England and Wales only.
	Health Services and Public Health Act 1968 (c.46)
	2 The Health Services and Public Health Act 1968 has effect subject to the following amendments.
	3 (1) Section 59 is amended as follows.
	(2) In subsection (1)—
	(a) after "local pharmaceutical services," insert "primary medical services,";
	(b) after "personal medical services," insert "primary dental services,".
	(3) In subsection (2), after "1977" insert "(in the case of pharmaceutical services)".
	(4) In subsection (2A), omit "section 28C of the 1977 Act,".
	(5) After subsection (2B) insert—
	"(2C) In subsection (1), the references to primary medical services and primary dental services are references to primary medical services and primary dental services provided under Part 1 of the 1977 Act or any corresponding provisions of the law in force in Northern Ireland or the Isle of Man."
	4 In section 63(2)—
	(a) after paragraph (a) insert—
	"(aa) the provision or performance of a primary medical service or primary dental service under Part 1 of the 1977 Act and an activity involved in or connected with the provision or performance of such a service;";
	(b) in paragraph (ba), omit "section 28C of the 1977 Act or".
	5 In section 64(3)(b), after "make arrangements" insert "or any service which a Primary Care Trust or Local Health Board is under a duty to provide under section 16CA or 16CC of that Act".
	Patents Act 1977 (c.37)
	6 (1) Section 56(4)(a) of the Patents Act 1977 is amended as follows.
	(2) After "the provision of—" insert—
	"(ai) primary medical services or primary dental services under Part 1 of the National Health Service Act 1977, or any corresponding provisions of the law in force in Northern Ireland or the Isle of Man, or".
	(3) In subparagraph (i), after "1977" insert "(in the case of pharmaceutical services)".
	(4) In subparagraph (ii), omit "section 28C of the 1977 Act,".
	National Health Service Act 1977 (c.49)
	7 The 1977 Act has effect subject to the following amendments.
	8 In section 3, at the end insert—
	"(4) For the purposes of the duty in subsection (1), services provided under—
	(a) section 16CA(2) or 16CC(2) below, or
	(b) a general medical services contract or a general dental services contract,
	are to be regarded as provided by the Secretary of State."
	9 In section 15(1)(a), for "general medical services, general dental services" substitute "primary medical services, primary dental services".
	10 In section 16BB(4), at the end insert "(including functions under sections 16CA to 16CC below)".
	11 In section 16BC(1), at the end insert "or sections 16CA to 16CC below".
	12 In section 18A(3)—
	(a) in paragraph (a), omit "general medical, general dental,"; and
	(b) for paragraph (b) substitute—
	"(b) providing or performing primary medical services or primary dental services under this Part,".
	13 (1) Section 26 is amended as follows.
	(2) In subsection (2) (as substituted by the National Health Service (Primary Care) Act 1997)—
	(a) in paragraph (a), omit "general medical services, general dental services";
	(b) for paragraph (b) substitute—
	"(b) providing services under a general medical services contract or a general dental services contract or in accordance with section 28C arrangements,".
	(3) In subsection (4)—
	(a) in paragraph (a), omit "general medical services, general dental services";
	(b) for paragraph (aa) substitute—
	"(aa) persons performing services under a general medical services contract or a general dental services contract or in accordance with section 28C arrangements".
	14 In section 28C(1)(a) and (b), (2)(a) and (b) and (4), for "personal", in all places, substitute "primary".
	15 (1) Section 28D is amended as follows.
	(2) In subsection (1)—
	(a) in paragraph (a), at the end insert "or NHS foundation trust";
	(b) in paragraph (f), at the end insert "or Local Health Board".
	(3) In subsection (2), in the definition of "qualifying body"—
	(a) in paragraph (a), for "(c)" substitute "(ba), (bb), (bc)";
	(b) in paragraph (b), for "personal" substitute "primary".
	16 In section 28I(a), for the words from "personal medical services" to "arrangements" substitute "primary medical services or primary dental services under this Part".
	17 (1) Section 41(1) is amended as follows.
	(2) In paragraph (b), after "medicines" insert "and listed appliances".
	(3) In paragraph (c)—
	(a) after "medicines" insert "and listed appliances";
	(b) for "general dental services" substitute "primary dental services".
	18 In section 43(1), for "general medical services or general dental services" substitute "primary medical services or primary dental services under Part 1 above".
	19 In section 43D(10)—
	(a) omit paragraphs (a) and (b);
	(b) for the words from "paragraphs" to "a services list prepared by" substitute "paragraphs (c) to (e), a supplementary list, a list under section 28W or a list corresponding to a list under section 28W prepared by".
	20 (1) Section 44 is amended as follows.
	(2) In the sidenote, for "local representative committees" substitute "Local Optical Committees and Local Pharmaceutical Committees".
	(3) Omit subsections (ZA1) to (B1).
	(4) In subsection (1)—
	(a) for the words from "a Health Authority" to "their area" substitute "a Local Health Board is satisfied that a committee formed for its area, or for its area and that of one or more other Local Health Boards";
	(b) for "the Health Authority" substitute "the Local Health Board".
	(5) Omit subsections (3)(a) to (d) and (5).
	21 (1) Section 45 is amended as follows.
	(2) In the sidenote, for "local representative committees" substitute "Local Optical Committees and Local Pharmaceutical Committees".
	(3) In subsection (1)—
	(a) for "Health Authorities" substitute "Local Health Boards";
	(b) omit paragraph (b).
	(4) In subsection (1ZA), omit paragraph (b) and the preceding "or".
	(5) In subsection (1A)—
	(a) omit "Strategic Health Authority";
	(b) for "Health Authority" substitute "Local Health Board".
	(6) In subsection (1C), for the words from "an area" to the end substitute "an area under subsection (B2)(b)(ii) of section 44 above shall, in respect of each year, determine the amount of its administrative expenses for that year attributable to the persons providing local pharmaceutical services in the Primary Care Trust's area".
	(7) In subsection (2), for "Health Authority", in both places, substitute "Local Health Board".
	(8) In subsection (3)—
	(a) for "Health Authority", in both places, substitute "Local Health Board";
	(b) omit "general medical services, general dental services,".
	(9) In subsection (4), for the words from "deputy medical practitioners" to "as the case may be" substitute "persons providing local pharmaceutical services".
	22 After section 45 insert—
	"45A Local Medical Committees
	(1) A Primary Care Trust may recognise a committee formed for its area, or for its area and that of one or more other Primary Care Trusts, which it is satisfied is representative of—
	(a) the persons to whom subsection (3) applies; and
	(b) the persons to whom subsection (4) applies.
	(2) A Local Health Board may recognise a committee formed for its area, or for its area and that of one or more other Local Health Boards, which it is satisfied is representative of—
	(a) the persons to whom subsection (3) applies; and
	(b) the persons to whom subsection (4) applies.
	(3) This subsection applies to—
	(a) every medical practitioner who, under a general medical services contract entered into by him, is providing primary medical services in the area for which the committee is formed; and
	(b) every medical practitioner who is providing general ophthalmic services in that area.
	(4) This subsection applies to every other medical practitioner—
	(a) who is performing primary medical services in the area for which the committee is formed—
	(i) pursuant to section 16CC(2)(a) above;
	(ii) in accordance with section 28C arrangements; or
	(iii) under a general medical services contract; and
	(b) who has notified the Primary Care Trust or Local Health Board that he wishes to be represented by the committee (and has not notified it that he wishes to cease to be so represented).
	(5) A committee recognised under this section shall be called the Local Medical Committee for the area for which it is formed.
	(6) Any such committee may delegate any of its functions, with or without restrictions or conditions, to subcommittees composed of members of that committee.
	(7) Regulations may require a Primary Care Trust or Local Health Board, in the exercise of its functions relating to primary medical services, to consult any committee recognised by it under this section on such occasions and to such extent as may be prescribed.
	(8) Regulations may require a Strategic Health Authority, in the exercise of any of its functions which relate to section 28C arrangements for the provision of primary medical services, to consult, on such occasions and to such extent as may be prescribed, any committee—
	(a) which is recognised by a Primary Care Trust under this section for the area where the services are (or are to be) provided under those arrangements; and
	(b) which is representative of persons providing or performing those services under those arrangements.
	(9) A committee recognised under this section shall have such other functions as may be prescribed.
	(10) A committee recognised under this section shall in respect of each year determine—
	(a) the amount of its administrative expenses for that year attributable to persons of whom its is representative under subsection (1)(a) or (2)(a); and
	(b) the amount of its administrative expenses for that year attributable to persons of whom it is representative under subsection (1)(b) or (2)(b).
	(11) A Primary Care Trust or Local Health Board may—
	(a) on the request of a committee recognised by it, allot to that committee such sums for defraying the expenses referred to in subsection (10)(a) as it may determine; and
	(b) deduct the amount of such sums from the remuneration of persons of whom it is representative under subsection (1)(a) or (2)(a) under the general medical services contracts, or arrangements under section 38 above, entered into by them with the Trust or Board.
	(12) A committee recognised under this section shall apportion the amount determined by it under subsection (10)(b) among the persons of whom it is representative under subsection (1)(b) or (2)(b); and each such person shall pay in accordance with the committee's directions the amount so apportioned to him.
	(13) References in this section to the administrative expenses of a committee include the travelling and subsistence allowances payable to its members.
	45B Local Dental Committees
	(1) A Primary Care Trust may recognise a committee formed for its area, or for its area and that of one or more other Primary Care Trusts, which it is satisfied is representative of—
	(a) the persons to whom subsection (3) applies; and
	(b) the persons to whom subsection (4) applies.
	(2) A Local Health Board may recognise a committee formed for its area, or for its area and that of one or more other Local Health Boards, which it is satisfied is representative of—
	(a) the persons to whom subsection (3) applies; and
	(b) the persons to whom subsection (4) applies.
	(3) This subsection applies to every dental practitioner who, under a general dental services contract entered into by him, is providing primary dental services in the area for which the committee is formed.
	(4) This subsection applies to every other dental practitioner—
	(a) who is performing primary dental services in the area for which the committee is formed—
	(i) under section 16CA(2) above;
	(ii) in accordance with section 28C arrangements; or
	(iii) under a general dental services contract; and
	(b) who has notified the Primary Care Trust that he wishes to be represented by the committee (and has not notified it that he wishes to cease to be so represented).
	(5) A committee recognised under this section shall be called the Local Dental Committee for the area for which it is formed.
	(6) Any such committee may delegate any of its functions, with or without restrictions or conditions, to subcommittees composed of members of that committee.
	(7) Regulations may require a Primary Care Trust or Local Health Board, in the exercise of its functions relating to primary dental services, to consult any committee recognised by it under this section on such occasions and to such extent as may be prescribed.
	(8) Regulations may require a Strategic Health Authority, in the exercise of any of its functions which relate to section 28C arrangements for the provision of primary dental services, to consult, on such occasions and to such extent as may be prescribed, any committee—
	(a) which is recognised by a Primary Care Trust under this section for the area where the services are (or are to be) provided under those arrangements; and
	(b) which is representative of persons providing or performing those services under those arrangements.
	(9) A committee recognised under this section shall have such other functions as may be prescribed.
	(10) A committee recognised under this section shall in respect of each year determine—
	(a) the amount of its administrative expenses for that year attributable to persons of whom it is representative under subsection (1)(a) or (2)(a); and
	(b) the amount of its administrative expenses for that year attributable to persons of whom it is representative under subsection (1)(b) or (2)(b).
	(11) A Primary Care Trust or Local Health Board may—
	(a) on the request of a committee recognised by it, allot to that committee such sums for defraying the expenses referred to in subsection (10)(a) as it may determine; and
	(b) deduct the amount of such sums from the remuneration of persons of whom it is representative under subsection (1)(a) or (2)(a) under the general dental services contracts entered into by them with the Trust or Board.
	(12) A committee recognised under this section shall apportion the amount determined by it under subsection (10)(b) among the persons of whom it is representative under subsection (1)(b) or (2)(b); and each such person shall pay in accordance with the committee's directions the amount so apportioned to him.
	(13) References in this section to the administrative expenses of a committee include the travelling and subsistence allowances payable to its members."
	23 In section 49N(1)—
	(a) in paragraph (a), for "49F(1)(a) to (e)" substitute "49F(1)";
	(b) in paragraph (c), for the words from the beginning to "a services list" substitute "a list under section 28W above, or any list corresponding to such a list".
	24 Section 53 (immunisation) shall cease to have effect.
	25 (1) Section 54 (as substituted by the National Health Service (Primary Care) Act 1997) is amended as follows.
	(2) In subsection (1)—
	(a) in paragraph (a), after "1973 or" insert "(prior to its repeal) section 29 of";
	(b) in paragraph (b), at the end insert "(prior to the coming into force of section 16CC above)";
	(c) after that paragraph insert "or
	(c) provided or performed primary medical services in accordance with section 28C arrangements, arrangements under section 16CC(2)(b) above or under a general medical services contract—
	(i) in prescribed circumstances, or
	(ii) if regulations so provide, in all circumstances,".
	(3) In subsection (2), in the definition of "relevant area"—
	(a) after "Primary Care Trust", in both places, insert ", Local Health Board";
	(b) after "by arrangement" insert "or contract";
	(c) for paragraphs (a) and (b) substitute "provided or performed services as specified in subsection (1) above".
	26 (1) Section 72 is amended as follows.
	(2) In subsection (5), at the end insert "and
	(d) persons providing primary medical services or primary dental services under a general medical services contract or a general dental services contract or in accordance with section 28C arrangements".
	(3) In subsection (6)(a), for "Part II" substitute "this Act".
	27 In section 77, at the end insert—
	"(4) This section does not apply in relation to the provision of any relevant dental service (within the meaning of section 79 below)."
	28 In section 78(3), for "paragraphs 2 and 5" substitute "paragraph 2".
	29 In section 83(a), for "to 79" substitute "and 78".
	30 In section 83A(1)(a), for the words from "section 77(1)" to "1997" substitute "section 77(1), 78(1) or 79 above".
	31 In section 85(1)—
	(a) insert "or" at the end of paragraph (bbb);
	(b) omit paragraph (e).
	32 (1) Section 98 is amended as follows.
	(2) In subsection (1)—
	(a) insert "and" at the end of paragraph (dd);
	(b) omit paragraph (e) and the preceding "and".
	(3) In subsection (4)—
	(a) in paragraph (a), omit the words from ", other than" to the end;
	(b) omit paragraph (b).
	33 In section 99(1)—
	(a) insert "and" at the end of paragraph (bb);
	(b) omit paragraph (f) and the preceding "and".
	34 In section 100(1)—
	(a) insert "and" at the end of paragraph (b);
	(b) omit paragraph (e) and the preceding "and".
	35 In section 103(1)(a)—
	(a) after "in respect of" insert "primary medical services or primary dental services provided by any person under Part 1 of this Act or of";
	(b) omit "or in accordance with section 28C arrangements".
	36 In section 105(2)(a), for the words from "as part of" to "arrangements" substitute "in the provision under this Act of primary medical services for that person".
	37 In section 126(4), after "19A(7) above" insert ", or by section 28E(3A), 28N, 28T or 28U above,".
	38 (1) In Section 128(1), at the appropriate places in alphabetical order insert—
	""general dental services contract" has the meaning given by section 28K above;";
	""general medical services contract" has the meaning given by section 28Q above;";
	""primary dental services" means services which are primary dental services for the purposes of Part 1 (see section 16CA);";
	""primary medical services" means services which are primary medical services for the purposes of Part 1 (see section 16CC)."
	39 In Schedule 8A, in paragraph 1(5), for the words from "personal medical" to the end substitute "primary medical services or primary dental services under any provision of, or made under, this Act."
	40 (1) Schedule 9A is amended as follows.
	(2) In paragraph 6, for paragraphs (a) and (b) substitute—
	"(a) health care professional of each description prescribed under section 28W above, provided that each such health care professional appointed is included in a list under that section;".
	(3) At the end of paragraph 6 insert—
	"For the purposes of paragraph (a) above, "health care professional" has the same meaning as in section 28W above."
	(4) In paragraph 10—
	(a) after "49N above" insert "or for the purposes of regulations under section 28W above containing provision corresponding to those sections";
	(b) for paragraph (a) substitute—
	"(a) if the practitioner is a health care professional of a description prescribed under section 28W above, one member of the panel must be a health care professional of the same description;
	(aa) if the practitioner is of a description referred to in paragraph 6(c) or (d) above, one member of the panel must be a practitioner of that description; and".
	(5) In paragraph 17(c), at the end insert "or under any provision of regulations under section 28W above corresponding to that provision".
	41 In Schedule 10, in paragraph 3, for "general medical services or personal medical services" substitute "or performed services as specified in section 54(1)".
	42 In Schedule 12, in paragraph 1(1)(b), for "accordance with section 28C arrangements or"" substitute "the provision of primary medical services under Part 1 or in accordance with".
	43 In Schedule 12A, insert "or" after paragraphs 1(2)(b), 2(2)(a), 4(2)(aa), 5(2)(a), 6A(2)(b) and 6B(2)(a).
	National Health Service (Scotland) Act 1978 (c.29)
	44 (1) Section 17D of the National Health Service (Scotland) Act 1978 is amended as follows.
	(2) In subsection (1)—
	(a) in paragraph (b)(ii), after "arrangements or" insert "primary medical services in accordance with";
	(b) in paragraph (c)(ii), after "arrangements or" insert "primary dental services in accordance with".
	(3) In subsection (2), in the definition of "NHS employee"—
	(a) in paragraph (b)(ii), after "arrangements or" insert "primary medical services in accordance with";
	(b) in paragraph (c)(i), for "36(1)(a)" substitute "28W";
	(c) in paragraph (c)(ii), after "arrangements or" insert "primary dental services in accordance with".
	Medical Act 1983 (c.54)
	45 The Medical Act 1983 is amended as follows.
	46 In section 11(4), in the definition of "medical practice"—
	(a) after "practitioners—" insert—
	"(za) perform primary medical services under Part 1 of the National Health Service Act 1977; or";
	(b) in paragraph (a), omit "Part II of the National Health Service Act 1977,";
	(c) in paragraph (b), omit "section 28C of the 1977 Act,".
	47 In section 12(2)(a), for "general medical services under Part II of the National Health Service Act 1977," substitute "primary medical services under Part 1 of the National Health Service Act 1977 or general medical services under".
	Dentists Act 1984 (c.24)
	48 In section 40(2) of the Dentists Act 1984, after paragraph (a) insert—
	"(aa) by a person providing primary dental services under section 28C of the National Health Service Act 1977 or under a contract under section 28K of that Act, or".
	Community Health Councils (Access to Information) Act 1988 (c.24)
	49 In section 1(6) of the Community Health Councils (Access to Information) Act 1988, in the paragraph 6B inserted into Schedule 12A of the Local Government Act 1972 (c.70)—
	(a) after paragraph (a) insert—
	"(aa) any particular person who is or was formerly included in, or is an applicant for inclusion in, a list under section 28W of that Act; or
	(ab) any particular person who is or was formerly providing services under a contract under section 28K or section 28Q of that Act; or";
	(b) in paragraph (b), for "such a person" substitute "a person mentioned in paragraphs (a) to (ab) above".
	Copyright, Designs and Patents Act 1988 (c.48)
	50 In section 240(4) of the Copyright, Designs and Patents Act 1988—
	(a) after "providing—" insert—
	"(za) primary medical services or primary dental services under Part 1 of the National Health Service Act 1977";
	(b) in paragraph (a)(i), after "1977" insert "(in the case of pharmaceutical services)";
	(c) omit paragraph (b)(i).
	Health and Medicines Act 1988 (c.49)
	51 The Health and Medicines Act 1988 has effect subject to the following amendments.
	52 In section 12(1)—
	(a) omit "The Dental Estimates Board shall be renamed as "the Dental Practice Board" and";
	(b) in paragraph (a), omit "for any reference to the Dental Estimates Board there were substituted a reference to the Dental Practice Board and";
	(c) in paragraph (b)—
	(i) omit "the Dental Estimates Board or",
	(ii) for "either or both of those Boards" substitute "that Board", and
	(iii) omit "the Dental Practice Board and".
	53 In section 17(1)—
	(a) omit "29, 36";
	(b) for "39 or 42" substitute "38, 39, 41 or 42".
	National Health Service and Community Care Act 1990 (c.19)
	54 (1) Section 18 of the National Health Service and Community Care Act 1990 is amended as follows (for so long as it has effect).
	(2) In subsection (1), for "Health Authority", in each place, substitute "Local Health Board".
	(3) In subsection (3), for paragraphs (a) and (b) substitute—
	"(a) a person or body who has entered into a contract under section 28Q of the principal Act, otherwise than in partnership; or
	(b) two or more individuals practising in partnership who together have entered into such a contract,".
	(4) In subsections (4) and (5), for "Health Authority", in each place, substitute "Local Health Board".
	(5) At the end insert—
	"(9) In this section, references to the "relevant" Primary Care Trust or Local Health Board, in relation to a practice, are to the Primary Care Trust or Local Health Board with which it has entered into a contract under section 28Q of the principal Act."
	Access to Health Records Act 1990 (c.23)
	55 (1) The Access to Health Records Act 1990 is amended as follows.
	(2) In section 1, in subsection (2), for paragraph (a) substitute—
	"(a) in the case of a record made by a health professional performing primary medical services under a general medical services contract made with a Primary Care Trust or Local Health Board, the person or body who entered into the contract with the Trust or Board (or, in a case where more than one person so entered into the contract, any such person);
	(aa) in the case of a record made by a health professional performing such services in accordance with arrangements under section 28C of that Act with a Primary Care Trust, Strategic Health Authority or Local Health Board, the person or body which made the arrangements with the Trust, Authority or Board (or, in a case where more than one person so made the arrangements, any such person);".
	(3) In that subsection, in paragraph (b), after "by a health service body" insert (and not falling within paragraph (aa) above)".
	(4) In section 7—
	(a) in subsection (2), omit the words from "(other" to "section 1(2)(a) above)"; and
	(b) omit subsection (3).
	(5) In section 11—
	(a) at the appropriate place, insert—
	"general medical services contract" means a contract under section 28Q of the National Health Service Act 1977;";
	(b) omit the definition of "general practitioner".
	(6) This paragraph extends to England and Wales only.
	Water Industry Act 1991 (c.56)
	56 In Schedule 4A to the Water Industry Act 1991, for paragraph 7 substitute—
	"7. Premises not falling within paragraph 5 or 6 above which are used for the provision of primary medical services or primary dental services under Part 1 of the National Health Service Act 1977."
	Trade Union and Labour Relations (Consolidation) Act 1992 (c.52)
	57 (1) Section 279 of the Trade Union and Labour Relations (Consolidation) Act 1992 is amended as follows.
	(2) In paragraph (a), omit "28C, 29, 35".
	(3) Renumber the existing provision as subsection (1).
	(4) After that provision insert—
	"(2) In this Act "worker" also includes an individual regarded in his capacity as one who works or normally works or seeks to work as a person performing primary medical services or primary dental services—
	(a) in accordance with arrangements made by a Primary Care Trust, Strategic Health Authority or Local Health Board under section 28C of the National Health Service Act 1977; or
	(b) under a contract under section 28K or 28Q of that Act entered into by him with a Primary Care Trust or Local Health Board,
	and "employer" in relation to such an individual, regarded in that capacity, means that Trust, Authority or Board".
	Health Service Commissioners Act 1993 (c.46)
	58 The Health Service Commissioners Act 1993 has effect subject to the following amendments.
	59 In section 2—
	(a) in subsection (1)(c), for the words from "exercising" to the end substitute "not exercising functions only or mainly in Wales";
	(b) in subsection (2)(b), for the words from "exercising" to the end substitute "not exercising functions only or mainly in England".
	60 (1) Section 2A is amended as follows.
	(2) In subsection (1)—
	(a) for paragraph (a) substitute—
	"(a) persons (whether individuals or bodies) providing services under a contract entered into by them with a Primary Care Trust under section 28K or 28Q of the National Health Service Act 1977";
	(b) in paragraph (c), for "personal", in both places, substitute "primary".
	(3) In subsection (2)—
	(a) for paragraph (a) substitute—
	"(a) persons (whether individuals or bodies) providing services under a contract entered into by them with a Local Health Board under section 28K or 28Q of the National Health Service Act 1977;";
	(b) in paragraph (c), for "personal", in both places, substitute "primary".
	61 In section 6(5)—
	(a) omit "29, 36";
	(b) for "39 or 42" substitute "38, 39, 41 or 42".
	62 In section 18(1), after "partly" insert "or wholly".
	Employment Rights Act 1996 (c.18)
	63 (1) Section 43K of the Employment Rights Act 1996 is amended as follows.
	(2) In subsection (1), after paragraph (b) insert—
	"(ba) works or worked as a person performing services under a contract entered into by him with a Primary Care Trust or Local Health Board under section 28K or 28Q of the National Health Service Act 1977,".
	(3) In subsection (2), after paragraph (a) insert—
	"(aa) in relation to a worker falling within paragraph (ba) of that subsection, the Primary Care Trust or Local Health Board referred to in that paragraph,".
	Education Act 1996 (c.56)
	64 In section 520(1) of the Education Act 1996, for "(1A)" substitute "16CB".
	Health Act 1999 (c.8)
	65 In Schedule 3 to the Health Act 1999, in paragraph 11(2)—
	(a) in subparagraph (c), for the words from "provide" to "under" substitute "perform primary medical services under Part 1 of";
	(b) in subparagraph (d), for the words from "provide" to "under" substitute "perform primary dental services under Part 1 of".
	Freedom of Information Act 2000 (c.36)
	66 In Schedule 1 to the Freedom of Information Act 2000, in Part 3, before paragraph 44 insert—
	"43A Any person providing primary medical services or primary dental services—
	(a) in accordance with arrangements made under section 28C of the National Health Service Act 1977; or
	(b) under a contract under section 28K or 28Q of that Act;
	in respect of information relating to the provision of those services."
	Health and Social Care Act 2001 (c.15)
	67 The Health and Social Care Act 2001 has effect subject to the following amendments.
	68 Section 18 shall cease to have effect.
	69 In section 28(4), for the words from "personal medical services" to the end substitute "primary medical services or primary dental services under any provision of, or made under, the 1977 Act."
	70 (1) Schedule 1 is amended as follows.
	(2) For paragraphs 11 and 12 substitute—
	"11. Information relating to a particular person who—
	(a) is or was formerly providing primary medical services or primary dental services under a contract under section 28K or 28Q of the 1977 Act;
	(b) is or was formerly included in, or is an applicant for inclusion in, a list under section 28W of the 1977 Act."
	(3) In paragraph 13, for ", 11 or 12" substitute "or 11".
	71 In Schedule 2, in paragraph 5(2), for paragraphs (c) and (d) substitute—
	"(c) primary medical services provided under Part 1 of the 1977 Act."
	National Health Service Reform and Health Care Professions Act 2002 (c.17)
	72 (1) Section 17 of the National Health Service Reform and Health Care Professions Act 2002 is amended as follows.
	(2) In subsection (1)—
	(a) after paragraph (f) insert—
	"(fa) persons providing primary medical services or primary dental services under Part 1 of the 1977 Act,"; and
	(b) in paragraph (g), omit the words from "or under" to "that Act".
	(3) In subsection (2), for "(1)(g)" substitute "(1)(fa), (g)".'.—[Mr. Hutton.]

Clause 141
	 — 
	Liability to Pay NHS Charges

Rosie Winterton: I beg to move amendment No. 235, in page 61, line 36, after 'injury' insert
	', whether physical or psychological,'.

Mr. Deputy Speaker: With this it will be convenient to discuss the following:Government amendments Nos. 236 and 237.
	Amendment No. 29, in page 63, line 15, at end insert—
	'(9A) No regulations may be made by the Secretary of State under this section unless a draft of the regulations has been laid before Parliament and approved by a resolution of each House.'.
	Government amendment No. 238.
	Amendment No. 30, in clause 144, page 67, line 22, at end insert—
	'(11) No regulations may be made under by the Secretary of State under this section unless a draft of the regulations has been laid before Parliament and approved by a resolution of each House.'.
	Government amendment No. 239.
	Amendment No. 31, in clause 148, page 71, line 22, at end insert—
	'(8) No regulations may be made by the Secretary of State under this section unless a draft of the regulations has been laid before Parliament and approved by a resolution of each House.'.
	Government amendment No. 240.
	Amendment No. 32, in clause 151, page 73, line 22, at end insert—
	'(3A) No regulations may be made by the Secretary of State under this section unless a draft of the regulations has been laid before Parliament and approved by a resolution of each House.'.
	Amendment No. 33, in clause 153, page 75, line 21, at end insert—
	'(3A) No regulations may be made by the Secretary of State under this section unless a draft of the regulations has been laid before Parliament and approved by a resolution of each House.'.
	Amendment No. 34, in clause 154, page 76, line 23, at end insert—
	'(4) No regulations may be made by the Secretary of State under this section unless a draft of the regulations has been laid before Parliament and approved by a resolution of each House.'.
	Amendment No. 35, in clause 155, page 76, line 40, at end insert—
	'(4A) No regulations may be made by the Secretary of State under this section unless a draft of the regulations has been laid before Parliament and approved by a resolution of each House.'.
	Government amendment No. 241.
	Amendment No. 36, in clause 156, page 77, line 16, at end insert—
	'(1A) No regulations may be made by the Secretary of State under this section unless a draft of the regulations has been laid before Parliament and approved by a resolution of each House.'.
	Amendment No. 37, in clause 181, page 95, line 35, after 'from', insert
	'regulations under sections 141, 144, 148, 151 or 153 to 156 or'.

Rosie Winterton: This part of the Bill was discussed in some depth in Committee. I hope that I will be able to show that the Government have listened and have responded positively to the concerns raised.
	Government amendments Nos. 235, 236 and 237 amend clause 141 and are intended to put an end to any concerns about the scope of the NHS costs recovery scheme. Our policy intention in relation to the scope of the NHS costs recovery scheme has always been clear. As my right hon. Friend the Minister of State said when this was discussed in Committee, free-standing diseases, particularly industrial diseases, are not covered by the scheme. It is our intention that both physical and psychological injury are covered. Nevertheless, some Committee members expressed genuine concerns about whether the Bill as then drafted left room for other interpretations, and my right hon. Friend agreed to reconsider the issue. We have decided to put the matter beyond doubt and the amendments seek to achieve that.
	Government amendment No. 235 confirms that psychological injury as well as physical injury is included in the scheme. That would cover, for example, the case of someone who received NHS treatment for post-traumatic stress disorder following a particularly harrowing incident for which they received compensation. The compensator would also be liable for NHS charges relating to the treatment.
	Government amendment No. 237 deals with questions that arose on the issue of disease itself. It makes it clear that free-standing disease, which would include, for example, asbestosis or mesothelioma, will not be within the scope of the scheme. There will be cases in which someone suffers an injury that leads to the development of a disease as a consequence of the injury. An example might be someone who suffers a broken leg that becomes infected and results in septicaemia. In such cases, if the disease is directly attributable to the original injury, it is clearly right that treatment of it should be included as part of the overall treatment of the injury for costs recovery purposes. The amendment makes that distinction clear.

Evan Harris: Committee members asked how that arrangement would work, even in a policy that we did not particularly like. I am grateful that the Government have tabled an amendment to clarify that. The remaining problem is whose decision it is, and on what basis they decide, that the disease in question is attributable to the injury suffered. One can usually tell when an injury is caused by an incident, and that would be covered. It is much harder to say whether a disease is attributable to an injury. Has the Minister given any thought to how that might be decided?

Rosie Winterton: Obviously, such cases would be linked to decisions made about personal injury claims, and there are two ways in which the decision might be forthcoming. One way would be through a court case where that had been established, and secondly, where an insurance company was settling a claim, there would be discussion about that and agreement would be reached. Clearly, if that gave rise to an appeal, the mechanism to deal with it exists.
	Government amendment No. 236 is the first of five minor drafting changes. Government amendment No. 237 specifies that only disease attributable to an injury should be taken into account for the recovery scheme, on the basis that treatment for such a disease is received as a result of the injury. Having used the words "as a result" in that amendment, we have been advised that the same wording should be used in clause 141 (1)(b)(i) and at various other places in this part of the Bill, in place of the original reference to treatment "in respect" of the injury. That ensures clarity and consistency in the test to be used in assessing whether treatment received is within the scope of the scheme. Government amendment No. 236 is the first of those technical changes.
	Opposition amendment No.29 seeks to amend clause 141 by making the regulation-making powers in that clause subject to the affirmative resolution procedure. Indeed, all the Opposition amendments—Nos. 29 to 37—try to do the same thing.
	With only one or two exceptions, the regulation-making powers in part 3 are not new. Rather, they mirror—sometimes word for word—powers that already exist in the Road Traffic (NHS) Charges Act 1999. Regulations made under the terms of that Act are all subject to the negative resolution procedure, and I see no reason why regulations made under the Bill, which will largely be concerned with the detailed and technical administration of the scheme, should be treated any differently.

Simon Burns: The Minister sees no reason why regulations made under the Bill should be treated any differently. Why does she think the original decision was taken to use the negative, not the affirmative, resolution procedure?

Rosie Winterton: For reasons of consistency, which we believe should continue in the Bill. The regulation-making powers are concerned largely with the administration of the scheme, and we believe that the time of the House would be better spent dealing with them through negative rather than affirmative resolution, especially as all the regulations are set out. I appreciate that the Opposition would prefer regulations to be made by affirmative resolution, but given the amount of time available to the House to discuss such matters, we believe that the negative procedure will be sufficient. Of course, the Opposition are free to pray against those regulations if they wish to do so.
	Government amendment No. 238 is one of a small number of minor technical drafting amendments, like amendment No. 236 which I have already covered, consequential on the wording of amendment No. 237. The intention is simply to ensure that references are consistent throughout this part of the Bill. Government amendment No. 239 is another minor drafting amendment consequential on the wording of amendment No. 237, as is Government amendment No. 240. Government amendment No. 241 is the last of the minor amendments designed to ensure consistency.
	I hope that hon. Members will accept that the Government amendments have been tabled in response to concerns raised in Committee and are intended to clarify the position, or are largely technical. I hope that hon. Members will also accept that the Opposition amendments are not only unnecessary, but would take up valuable time of the House, particularly when they repeat what already exists in legislation. I ask the House to accept the Government amendments and reject those of the Opposition.

Chris Grayling: It is clear from the Minister's last remarks that she does not understand the importance of this part of the Bill to many outside groups, small businesses, GPs and organisations that provide insurance to GPs. If this part were implemented wrongly, it could have a significant effect on the welfare and possibly even the survival of a number of smaller businesses. I shall therefore challenge what the Minister said about the negative and affirmative approach to future statutory instruments, and attempt to convince her that she is wrong about that aspect of the measure.
	It is true that we have received from the Government some clarification of their intentions in the Bill. In Committee we debated a number of provisions that were vague and confusing, and the Minister has gone some way to clarifying the Government's intentions, but in doing so, she has created additional confusion. I shall deal with some elements of the confusion that arises from the changes that she has made.
	It was clear from the comments of the Minister of State, the right hon. Member for Barrow and Furness (Mr. Hutton), in Committee that the measure was intended to apply solely to injury. As the hon. Lady rightly said, we raised the issue of long-term chronic conditions and the fact that it was impossible for the insurance industry to plan for those, as such conditions sometimes emerge years after the event. The Government's focus on injury specifically was welcome and helped to clarify their intentions.
	However, I remain uncertain, as do my hon. Friends, about some aspects of what is proposed in the Government's amendments. The Minister spoke about psychological injury. It is appropriate that we should recognise that injury is not always physical and that it is sometimes psychological. The hon. Lady set out a good example in which this aspect of the Bill might be applied—the case of a substantial and distressing public event, following which a large number of people were treated for shock, post-traumatic stress disorder and other psychological conditions that resulted from experiencing or being an eye-witness to the incident.
	In the case of a major sporting event, the impact on the organisers could be substantial. We need only think back to some of the more terrible incidents that we have experienced in this country in recent years, such as the Bradford City fire and the Hillsborough disaster, in which large numbers of people were affected by direct experience of an appalling situation. Sports clubs that must insure against the risks to them could face huge problems. [Interruption.]

Mr. Deputy Speaker: Order. I am being distracted by conversations while the hon. Member for Epsom and Ewell (Chris Grayling) is addressing the Chamber.

Chris Grayling: In assessing the risk associated with large-scale sporting events or public events of any variety, including rock concerts or open-air classical concerts, the insurance industry will have to take into account the possibility of reimbursing to the national health service the cost of treating people who have suffered shock and other psychological aftermaths as a result of a major incident of the sort that we hope will not occur too often. That will be factored into insurance premiums in future.
	What discussions has the Minister had with the insurance industry about that issue? Has she made any assessment of how the Government could limit the measures? In Committee, the Minister of State, the right hon. Member for Barrow and Furness, said that he would cap the payout that an insurance company could have to make in an individual case. Of course, as a large number of payouts could be made in relation to an individual incident, insurance organisations and event organisers could face substantial payouts, as a single incident might affect not only one person but a range of people. Will the Minister clarify that point?
	I should also like clarification in respect of disease acquired from injury. The Minister cited the example of septicaemia. We can all understand how that would feature in a case for personal injury. She will be aware, however, of the very widespread incidence of MRSA, a hospital-acquired infection. She and her colleagues have indicated that health care providers will not be exempt from the provisions. What is the position in respect of infection acquired as a consequence of having an injury, rather than as a direct result of the injury itself? Where will she draw the dividing line, especially in respect of claims against the national health service? Treatment for an injury and an adverse incident of the sort that many people experience when they pick up MRSA in a hospital might be indistinguishable in that context. What about somebody who falls out of a bed in a hospital because they have not been properly protected with barriers at the side of the bed? That happened to an elderly gentleman in my constituency a few weeks ago and he contracted a hospital-acquired infection. How will the distinction be made in law?
	Our amendments need to be seen in the light of the substantial number of unanswered questions in the Bill. We received a number of assurances from the Minister of State, the right hon. Member for Barrow and Furness, that various limitations would be put in place. For example, he said that a maximum amount would be retrievable by the national health service under the Bill. Of course, the Bill does not specify that maximum amount, which will be subject to regulations. Various provisions in clauses 144 and 141 give the Government the freedom to modify the scheme, whether to withdraw eligible circumstances in which payments can be made to the NHS or to add to them. Frankly, I do not accept what the Minister said about the road traffic measure and the negative procedure. I suspect that the argument that we are having tonight about the affirmative and negative procedures also occurred when that measure was debated.
	As was amply demonstrated by the very good piece of work done by the Department for Work and Pensions on the problems that employers are facing because of the rising cost of compulsory employers liability insurance, if the Government get this measure wrong, it will have a significant adverse effect on smaller businesses in particular. Therefore, it is not good enough to send the Government forth from this place with a free hand and the ability to make regulations and push them through with the negative procedure. I know that business groups are less than satisfied with what the Government are doing and do not feel that they understand the consequences of even a limited scheme for the cost of liability insurance in respect of smaller employers who already face a substantial increase in costs as a result of circumstances in recent years. They will pay more at a time when they can ill afford to do so.
	I am grateful to the Minister and her colleague, the Minister of State, the right hon. Member for Barrow and Furness, for saying that the Government would wait at least until the Department for Work and Pensions review is completed before implementing the measure. I find it surprising that it was drafted in separation from that process, but it is welcome that they have agreed to delay it. None the less, when the Government come to frame the regulations off the back of that DWP work and the measures set out in the Bill, they should come back to the House and seek its consent. They should not hope that hon. Members will spot the regulations when they have been tabled and pray against them. The issue is too significant for the small businesses of this country. There is no reason why the regulations should not be made a matter of mandatory debate in this House. The issue is important and it is a shame that the Government do not feel it appropriate to tell the House that it will automatically have a chance to debate this issue and to challenge them over it. That is to be regretted. I hope that, even at this stage, the Government may change their mind and that the Minister will accept that the affirmative rather than the negative route is the right one.

Evan Harris: I have two brief questions for the Minister. First, does the provision that she has made to distinguish between injury and illness and to provide for illness directly resulting from injury mirror the equivalent road traffic measure? Does she intend it to do so for consistency?
	Secondly, I mentioned that the only problem that I envisaged was working out what illnesses were attributable to an injury, but I have a further question about that issue, which was prompted by the remarks of the hon. Member for Epsom and Ewell (Chris Grayling). The Minister argues that injury may be "physical or psychological". The amendment does not refer to physical and/or psychological injuries or to physical and psychological injuries, but allows for psychological injuries alone. I imagine that she may have in mind post-traumatic stress disorder, but it is hard to argue that that is not an illness rather than an injury. As an illness, it would not be countered by virtue of Government amendment No. 237, which seeks to introduce into clause 141 a new subsection (4A):
	"'Injury' does not include any disease."
	One might argue that post-traumatic stress disorder is more like a disease or condition than an injury. In the absence of any physical trauma—I think that that is the distinction on which she and her draftsmen are relying, which is logical—it is hard to see how post-traumatic distress disorder and other purely psychological injuries might be considered injuries, as they are more likely to be considered illnesses when push comes to shove, such as in the event of an appeal, as the trauma causing the condition will not exist in that instance. I should be grateful for clarification.

Rosie Winterton: I take on board the points made by the hon. Member for Epsom and Ewell (Chris Grayling) about businesses feeling that they have to bear an added weight as a result of the Bill. We need to be clear, however: if an employer did not have proper health and safety measures in place and their negligence resulted in injury to an individual who was subsequently awarded compensation through a personal injury claim, surely it is only right that the employer should pay back to the NHS the costs of the treatment. That principle is embodied in the part of the Bill under discussion and I think that we should all welcome it.
	The hon. Gentleman referred to the fact that the Minister of State, my right hon. Friend the Member for Barrow and Furness (Mr. Hutton), said that we would not implement the provisions until the Department for Work and Pensions had finished its review of liability insurance and so on. However, the principles are very clear. Given that background, I turn to the specific points raised by the hon. Member for Epsom and Ewell. On sporting events, if negligence on the part of an organiser results in personal injury claims, those provisions will apply. 8 pm
	On the setting of caps, that will be done by regulations, but our intention is that it will be in line with the current road traffic tariffs—that is, £452 for an out-patient charge and £556 for an in-patient daily rate fee, with a £33,000 cap.

Chris Grayling: Taking the Minister back to sporting events, one of the bodies that will be affected is the police. If she thinks back to the Hillsborough disaster, the police were ultimately held responsible for operational mistakes made on the ground. Financially speaking, the police face a potentially huge challenge in catering for such an eventuality, given that, tragically, mistakes are sometimes made.

Rosie Winterton: That would follow on from the winning of personal injury claims; the same point was made about the national health service. We think that it is right that the provisions have to apply across the public bodies, not just in the private sector. If a personal injury claim is made and settled, it is only right that the appropriate body pays for the care.
	MRSA would not be covered in the way that the hon. Gentleman suggests, because there would be a separate intervening cause that was not part of the original injury. Obviously, there are other mechanisms for redress in those circumstances.
	On post-traumatic stress disorder, the scheme will apply only if a person has been able to sue someone for damages. Several of the cases that the hon. Gentleman raised would not concern a personal injury claim; that may well apply to the major sporting events that he talked about.
	The distinction in the Bill does not mirror the Road Traffic (NHS Charges) Act 1999, which will be repealed when the Bill takes effect. It does not apply solely in relation to those provisions, which focus on injuries caused by the use of a motor vehicle on a road.
	I shall be more than happy to write to hon. Members about any matters that I have been unable to cover. Having given those assurances and further explanations, I hope that hon. Members will feel able to support the Government amendments and reject those of the Opposition.
	Amendment agreed to.
	Amendments made: No. 236, in page 61, line 39, leave out 'in respect' and insert 'as a result'.
	No. 237, in page 62, line 28, at end insert—
	'(4A) "Injury" does not include any disease.
	(4B) Nothing in subsection (4A) prevents this Part from applying to—
	(a) treatment received as a result of any disease suffered by the injured person, or
	(b) ambulance services provided as a result of any disease suffered by him,
	if the disease in question is attributable to the injury suffered by the injured person (and accordingly that treatment is received or those services are provided as a result of the injury).'.
	No. 252, in page 62, line 36, leave out from beginning to 'an' and insert 'other treatment provided by'.
	No. 268, in page 62, line 44, leave out from 'section 16CA' to end of line 45 and insert
	', 16CC, 28C, 28K or 28Q of the 1977 Act (primary medical and dental services), or'.
	No. 269, in page 63, line 4, at end insert—
	'( ) In relation to any time before sections (provision of primary medical services) and (general medical services contracts) come into force, the references in subsection (5)(d)(i) to sections 16CC and 28Q of the 1977 Act are to be taken as a reference to section 29 of that Act (arrangements for general medical services).'.—[Ms Rosie Winterton.]

Clause 144
	 — 
	Information Contained in Certificates

Amendment made: No. 238, in page 66, line 22, leave out
	'in respect, or as a result,'
	and insert 'as a result'.—[Ms Rosie Winterton.]

Clause 148
	 — 
	Appeal Against a Certificate or a Waiver Decision

Amendment made: No. 239, in page 70, line 26, leave out 'in respect' and insert 'as a result'.—[Ms Rosie Winterton.]

Clause 151
	 — 
	Provision of Information

Amendment made: No. 240, in page 73, line 13, leave out 'in respect' and insert 'as a result'.—[Ms Rosie Winterton.]

Clause 156
	 — 
	Power to Apply Part 3 to Treatment at Non-Health Service Hospitals

Amendment made: No. 241, in page 77, line 7, leave out 'in respect' and insert 'as a result'.—[Ms Rosie Winterton.]
	It being seven hours after the commencement of proceedings on the programme motion, Mr. Deputy Speaker proceeded to put forthwith the Questions necessary for the disposal of the business to be concluded at that hour, pursuant to Order [this day.]

New Clause 23
	 — 
	Replacement of the Welfare Food Schemes: Northern Ireland

'An Order in Council under paragraph 1(1) of the Schedule to the Northern Ireland Act 2000 (c.1) (legislation for Northern Ireland during suspension of devolved government) which contains a statement that it is made only for purposes corresponding to those of section 172 above—
	(a) is not subject to paragraph 2 of that Schedule (affirmative resolution of both Houses of Parliament), but
	(b) is subject to annulment in pursuance of a resolution of either House of Parliament.'.—[Jim Fitzpatrick.]
	Brought up, read the First and Second time, and added to the Bill.

Clause 184
	 — 
	Commencement

Amendments made: No. 313, in page 96, line 22, leave out
	'Chapter 8, sections 109, 111'
	and insert '104, 106, 111(1)'.
	No. 314, in page 96, line 27, leave out '108, 110' and insert '111(1A)'.
	No. 315, in page 96, line 30, leave out 'and 105' and insert
	'105, (Complaints about health care), (Complaints about social services), (Complaints regulations: supplementary), 111(2), (Representations relating to special guardianship support services), paragraph 4 of Schedule 8 and section 182 and Schedule 13 so far as relating to those provisions'.
	No. 231, in page 97, line 5, leave out from second 'to' to end of line and insert
	'sections 158, (Replacement of the Welfare Food Schemes: Northern Ireland) or'—[Jim Fitzpatrick.]

Clause 187
	 — 
	Extent

Amendment made: No. 232, in page 98, line 1, at end insert—
	'( ) section (Replacement of the Welfare Food Schemes: Northern Ireland);'.—[Jim Fitzpatrick.]

Schedule 13
	 — 
	Repeals and Revocations

Amendments made: No. 319, in page 152, line 14, at end insert
	'Children Act 1989 (c. 41)Section 14G.'.
	No. 300, in page 153, line 30, leave out from beginning to end of line 28 on page 157 and insert—
	
		
			 Reference Extent of repeal or revocation 
			 National Health Service (Amendment) Act 1949 (c.93) The whole Act. 
			 Parliamentary Commissioner Act 1967 (c.13) In Schedule 3, in paragraph 8(1), "the Dental Practice Board or". 
			 Health Services and Public Health Act 1968 (c.46) In section 59(2A), "section 28C of the 1977 Act,". In section 63(2)(ba), "section 28C of the 1977 Act or".House of Commons Disqualification Act 1975 (c.24) In Schedule 1, in Part 3, the entry relating to the Chairman or Vice-Chairman of the Dental Practice Board or member of that Board appointed at an annual salary. 
			 Race Relations Act 1976 (c.74) In Schedule 1A, in Part 2, the entry relating to the Dental Practice Board. 
			 Patents Act 1977 (c.37) In section 56(4)(a)(ii), "section 28C of the 1977 Act,". 
			 National Health Service Act 1977 (c.49) In section 3(3), "medical, dental,". Section 5(1A). In section 18A(3)(a), "general medical, general dental,". In section 26(2)(a) and (4)(a), "general medical services, general dental services". Section 28C(3) and (7). In section 28D(2), the definitions of "qualifying dental practitioner" and "qualifying medical practitioner". Section 28DA. In section 28E—  in subsection (2), paragraph (b) and the words following that paragraph;  subsection (3)(f), (g) and (j);  subsections (5) to (8). Sections 28F to 28H. Sections 29 to 37. Section 43ZA(3)(a) and (b). In section 43C(3), in the definition of "Part II services" the words "general medical services, general dental services,". In section 43D—  in subsection (1), "general medical services, general dental services,";  subsection (10)(a) and (b). In section 44—  subsections (ZA1) to (B1);  subsection (3)(a) to (d);  subsection (5). In section 45—  subsection (1)(b);  subsection (1ZA)(b) and the preceding "or";  in subsection (1A), "Strategic Health Authority";  in subsection (3), "general medical services, general dental services"; Section 49F(1)(a) and (c). In section 49H(1)(a), "or a dental corporation". In section 52, "general medical services, general dental services,". Section 53. Section 56(a) and (b). In section 72(5)(a), ", dental practitioners,". In section 78—  in the side-note, "dental or";  subsections (1A) and (2). Section 81(b). Section 82(b). Section 83(b). Section 85(1)(e). In section 98—   subsection (1)(e) and the preceding "and";  in subsection (4), in paragraph (a), the words from ", other than" to the end, and paragraph (b). Section 99(1)(f) and the preceding "and". Section 100(1)(e) and the preceding "and". Section 102(1)(a)(iii) and (iv) and (2)(b) and (c). In section 103(1)(a), "or in accordance with section 28C arrangements". In section 126(4), the words from "regulations made under section 32" to "or to" In section 128(1)—  the definitions of "dental corporation", "medical list", "personal dental services" and "personal medical services";  in the definition of "terms of service", the words "general medical services, general dental services,". In Schedule 1—  in the title, "and their education in dental health";  in paragraph 1(a), "or dental" and "or for education in dental health". In Schedule 12—  in the heading preceding paragraph 2, "dental or";  in paragraph 2, sub-paragraphs (3) to (7) and, in sub-paragraph (8), the words from "and, in the case of" to the end;  paragraph 3 and the preceding heading;  paragraphs 6 and 7. In Schedule 12A—   paragraph 1(2)(d) and the preceding "or";  paragraph 2(2)(c) and the preceding "or";  paragraph 4(2)(b) and the preceding "or";  paragraph 5(2)(b) and the preceding "or";  paragraph 6A(2)(d) and the preceding "or";  paragraph 6B(2)(c) and the preceding "or". National Health Service (Scotland) Act 1978 (c.29) Section 17A(2)(g). Health Services Act 1980 (c.53) In Schedule 5, paragraphs 2(3) and 4. Health and Social Services and Social Security Adjudications Act 1983 (c.41) Section 14(1). Section 15(a). In Schedule 6, paragraph 2. Medical Act 1983 (c.54) In section 11(4), in the definition of "medical practice"—  in paragraph (a), "Part II of the National Health Service Act 1977,";  in paragraph (b), "section 28C of the 1977 Act,". In Schedule 5, paragraph 16(a). Dentists Act 1984 (c.24) In section 40(2)(ab), "section 28C of the National Health Service Act 1977 or". In Schedule 5, paragraph 8. Health and Social Security Act 1984 (c.48) In Schedule 3, paragraph 5. Income and Corporation Taxes Act 1988 (c.1) Section 519A(2)(f). Copyright, Designs and Patents Act 1988 (c.48) Section 240(4)(b)(i). Health and Medicines Act 1988 (c.49) In section 2(1)(a)—  in sub-paragraph (i), "Part II of the National Health Service Act 1977 or";  in sub-paragraph (ii), "section 28C of the 1977 Act or". In section 8(1)—  in paragraph (a), "section 29 of the National Health Service Act 1977 or";  in paragraph (b), "section 36 of the National Health Service Act 1977 or". In section 12(1)—   "The Dental Estimates Board shall be renamed as "the Dental Practice Board" and";  in paragraph (a), "for any reference to the Dental Estimates Board there were substituted a reference to the Dental Practice Board and";  in paragraph (b), "the Dental Estimates Board or" and "the Dental Practice Board and". Section 12(2) and (3)(a). In section 17—  in subsection (1), "29, 36";  subsection (2)(b) and the preceding "and". In Schedule 2, paragraphs 4 to 6, 7(1) and (2) and 8(2) and (3). National Health Service and Community Care Act 1990 (c.19) In section 4(2)(g), "the Dental Practice Board or". Section 18(7). Sections 23 and 24. Section 60(7)(f). Access to Health Records Act 1990 (c.23) In section 7—  in subsection (2), the words from "(other" to "section 1(2)(a) above"  subsection (3).  In section 11, the definition of "general practitioner". Trade Union and Labour Relations (Consolidation) Act 1992 (c.52) In section 279(a), "28C, 29, 35". Health Service Commissioners Act 1993 (c.46) Section 2(1)(f). In section 6(5), "29, 36". Health Authorities Act 1995 (c.17) In Schedule 1, paragraphs 18 to 26. Medical (Professional Performance) Act 1995 (c.51) In the Schedule, paragraph 28. Employment Rights Act 1996 (c.18) In section 43K(1)(c)(i), "29, 35". Section 218(10)(d). National Health Service (Primary Care) Act 1997 (c.46) Part 1. Section 23(1). Section 24(1). Section 25(1). Section 32. Section 40(1) and (3). Schedule 1. In Schedule 2, paragraphs 6, 8 to 12, 16 to 19, 24, 25, 71 to 73, 80 and 81. Health Act 1999 (c.8) Section 6(1). Section 9(2) and (3). In section 10(1)—  in the section 43A inserted into the National Health Service Act 1977, in subsection (1), "general medical services, general dental services,";  in the section 43B so inserted, in subsection (6), the words from "Subject to" to "35(2) above,". Section 11(2). Section 39(2) and (3). In section 61(2), the words from ", or Part 1" to "1997,". In Schedule 3, paragraph 11(3). In Schedule 4—  in paragraph 2, "section 29(4) of the 1977 Act and";  paragraphs 17 and 88. National Assembly for Wales (Transfer of Functions) Order 1999 (S.I.1999/672) In Schedule 1, in the entry for the National Health Service Act 1977, paragraphs (c) and (e). Freedom of Information Act 2000 (c.36) In Schedule 1, in Part 3—   paragraph 42;  in paragraph 44, "general medical services, general dental services,";  paragraph 45. Health and Social Care Act 2001 (c.15) Section 15. Sections 17 and 18. Section 20(2) to (4). Section 22 .Section 23(2) and (3). Section 26.  Section 27(5). In section 41(1)—  in paragraph (a), "(provision of personal medical or dental services)";   paragraph (b) and the preceding "or". In Schedule 5, paragraphs 5(4) to (7), 11(2) and (3) and 12(2). National Health Service Reform and Health Care Professions Act 2002 (c.17) Section 4(1). Section 5(2), (3) and (6) In section 17(1)(g), the words from "or under" to "that Act". In Schedule 1, paragraph 17. In Schedule 2, paragraphs 3 to 10 and 72. In Schedule 3, paragraphs 2 to 6, 10 and 15 to 17. In Schedule 8, paragraph 2. 
		
	
	Note The repeals in this Part of this Schedule to the following enactments extend to England and Wales only—
	(a) the National Health Service (Amendment) Act 1949 (c.93);
	(b) the Access to Health Records Act 1990 (c.23);
	(c) the National Health Service (Primary Care) Act 1997 (c.46) and enactments amending that Act.'.
	Order for Third Reading read.—[Queen's Consent, on behalf of the Crown, and Prince of Wales's consent, on behalf of the Duchy of Cornwall, signified.]
	Motion made, and Question proposed, That the Bill be now read the Third time.—[Dr. John Reid.]

John Reid: As several speakers have said, there is never sufficient time to examine and debate a subject as important as this, but today's has been a long debate that is the culmination of previous long discussions.

Patrick McLoughlin: Will the Secretary of State give way?

John Reid: It looks as though the debate is going to be even longer.

Patrick McLoughlin: The Secretary of State said that there can never be sufficient time to deal with this subject, but the other place will not have a time restraint put on it. Does the right hon. Gentleman not find it rather odd that the elected House is timetabled, yet the unelected House can speak on the Bill for as long as it likes?

John Reid: Of course the other House is constrained by its own conventions. I do not know whether the hon. Gentleman was making a threat; I suspect that he was. If so, I remind him that this House—specifically the majority of this House who form the Government—has a mandate from the people of this country, especially when it comes to decentralising power and modernising the national health service.

Simon Burns: Not on foundation hospitals.

John Reid: Let me tell the hon. Gentleman that if the Labour Government have one mandate it is to defend and modernise the national health service. Since we have done that successfully for six decades, I do not see any reason why we should change now.

Liam Fox: Purely on a technicality, can the Secretary of State tell us which part of the Labour party manifesto mentioned foundation hospitals?

John Reid: The manifesto contains several references to the defence of the national health service, to putting patients first and to decentralising decision making. Once again, the hon. Gentleman is wrong. It has not been a particularly good week for foxes, and that has not changed tonight.

Howard Stoate: Does my right hon. Friend agree that the real issue surrounding the Bill is that people deserve a modern health service that is accountable to the people and gives them more flexibility, more control over local services and more choice? That is what this Government are trying to do. The Opposition are trying to get rid of the health service and privatise it, while we want to modernise it and bring it into the 21st century to provide the level of care that people deserve.

John Reid: Even though I am well used to the articulacy of my hon. Friends, I am sometimes astounded by just how articulate and on the mark their comments can be. I could not have put it better myself.
	I begin by paying a courteous tribute to my predecessor, my right hon. Friend the Member for Darlington (Mr. Milburn) for all his work, and to my Ministers, especially the Minister of State, my right hon. Friend the Member for Barrow and Furness (Mr. Hutton), who has performed so admirably today. I say with total modesty that he has carried the weight of the Bill. He is a great asset to me, my team and the Government.
	The Government have a proud record of investing in and developing the national health service. That is not only because politically it is a child of the movement, but because morally it has long been at the centre of our values that no one in this country should be deprived, through lack of finance or station in life. of health care when needed, free at the point of need. Such a national health service, through collective provision, is increasingly not only a moral but a circumstantial imperative. As our health becomes more predictable through advances in genetics—they may not become definitive for some considerable time but they must be taken into account—the NHS becomes more, not less relevant. That is especially true when the health service is compared with private health insurance. Any health insurance actuary who is doing his job will give the minimum coverage to those who need it most. Actuaries are paid to do that. [Interruption.]

Mr. Deputy Speaker: Order. The Chair frowns on electronic devices in the Chamber. I wish hon. Members would ensure that they were turned off before they came into the Chamber.

John Reid: I was explaining why the NHS is so important to us and why we are intent on ensuring that it will be as effective and well supported in future as it has been in the past.
	We introduced the Bill because the same strong belief in the values that drove the architects of the NHS endure to persuade me, the Government and, I hope, all other Labour Members to support the measure.

Simon Burns: Not all of them.

John Reid: The hon. Gentleman may point to differences in the Labour party, and I would be the last to deny them, but they are as nothing compared with the yawning chasm between all Labour Members and the hon. Gentleman over the real dividing line: our insistence that everyone in this country has health care when it is needed, free at the point of need. I shall refer to that later.
	The Bill and the changes in it are intended to ensure that the NHS survives and thrives for future generations as it has done for the past six decades—three or four generations. We intend it to serve our children and grandchildren as it served our parents and grandparents: as a national health service free at the point of need, without regard to background or station in life.
	Our challenge, the response to which is enshrined in the Bill, is to ensure that the same values that underpinned the NHS remain in a service that fulfils the rising expectations and ambitions of current and succeeding generations. The Labour party, which forms the Government, can claim to have been a central dynamo over the past century in ensuring that the influence as well as the affluence of working people in this country increased with each generation. We rejoice that one of the effects is that their expectations and ambitions increase with every generation. Our job is not only to provide a socially just system of Government and public service but to develop that system and service for each generation.
	It is the job of those of us who believe in the NHS to ensure that people's desired choice and increased expectations can be fulfilled in the NHS. Otherwise, we will do the NHS a great disservice. As people in this country become better off, they will make choices, fulfil their ambitions and have their expectations met. They will do that because, as their expectations rise, increasing financial affluence allows them to make choices. It is our job to ensure that we develop a national health service in which expectations can be met rather than forcing those who wish to fulfil their ambitions to go outside the NHS.

Graham Allen: Will my right hon. Friend consider that a key factor in providing such a health service and such choices might be a period of stability, not least for him and his new, welcome Front-Bench team, thus allowing people a year or possibly two in which the many changes that have been introduced in recent years can bed in, and letting staff and patients use the NHS in the way he outlined?

John Reid: I have discussed the matter with my hon. Friend. We do not agree about everything but I take the sense of his point. However, I cannot say to any organisation—my party, Parliament or the services that serve the people of this country—that it can exist in a world that does not change. As one old philosopher said, the only constant is change. I cannot promise that the NHS will be isolated from the necessity to change. I take my hon. Friend's point that sudden lurches and changes in direction, pulling back and stopping and starting are most debilitating for a service that wants to use the increased capacity that we are providing to the best effect. I was therefore pleased to tell the NHS Confederation last week that, although in a sense the big challenge is that change occurs, the good news is that the direction of change will not shift. In partnership, we want to work out how we can increase the momentum of that change, but I take my hon. Friend's point that we do not want yet another road map, road sign and direction for everyone.
	It is important to recognise that, whatever our differences over introducing change, they are minuscule compared with the big debate about the essential nature of the health care system that future generations will inherit. Not everyone wants us to succeed in the task of modernisation because not everyone shares the values on which the NHS is based. Those values are under attack from the Opposition who want to introduce finance into the relationship between doctor and patient. The Conservative party is capable of reducing the highest moral values to the cash nexus. It has a genius for that, despite the fact that we know from experience how that affects the human condition. For example, the United States has a health system that the Opposition greatly admire, and no less than 40 per cent. of all personal bankruptcies are attributable to people's inability to find the money to pay for their health care.

Liam Fox: I hope I can save the Secretary of State time by stopping him peddling the myth that Conservative Members are attracted by the American system. We have gone out of our way to say that we are not attracted by it. But we are very attracted by the social insurance systems of other European countries. Why do the Chancellor and the Secretary of State insist, Don Quixote-like, on chasing monsters that they have imagined?

John Reid: That is an interesting intervention. I believed that the hon. Gentleman was pledged to a system of patient passports, as he calls them—vouchers that are equal to approximately 60 per cent. of the cost of an NHS operation. That would be given to individuals at the same time as the Conservatives would cut—

Liam Fox: Finland. The Netherlands.

John Reid: The hon. Gentleman mentions Finland and the Netherlands. I like the British NHS. It has served us well. The idea of eager little Tory Front-Bench spokesmen scuttling around Finland doing a little fishing and trying to pick up an NHS that is better than ours is mind-boggling. However, the Opposition plough ahead with a plan that would mean that patients, including pensioners, have to pay up to £4,000 or £6,000 for a hip operation and £1,000 to £2,000 for a cataract operation. That is their PPP—poor pensioners paying for Tory health policy.

Liam Fox: Will the Secretary of State give way?

John Reid: I shall be more than happy to help the hon. Gentleman dig himself even deeper into the hole.

Liam Fox: Our politics have reached a sad state when, rather than defending his own Bill, a Minister goes off at a tangent and starts referring to utterly untrue allegations about what the Opposition have said. What we have said is perfectly clear: we have said that patients will be entitled to free care in the NHS in their own or any other hospitals when that is what they want. Only if they themselves decide to go outside the NHS will they get some of their own tax back to help them—and that is something they are denied by the present Government.

Mr. Deputy Speaker: Order. Before the Secretary of State responds, I should point out that Third Reading debates are designed for debate of the content of Bills. Perhaps hon. Members on both sides of the House could now do just that.

John Reid: Absolutely, Mr. Deputy Speaker.
	One thing that the Bill was designed to avoid was any suggestion that patients would have to pay up to, say, £5,000 for a hip replacement—

Mr. Deputy Speaker: Order. I should be grateful if the Secretary of State would heed my advice.

John Reid: I thought I was, Mr. Deputy Speaker, but if you wish me to avoid the subject of the cost—[Interruption.] I must say that Conservative Front Benchers do not seem very eager to espouse their own policies.

Evan Harris: One part of the Bill reconfirms the existence of dental charges. Let me ask a serious question. I accept that the Secretary of State is genuinely concerned about lack of wealth being a barrier to access. Has he reflected on a report by the National Association of Citizens Advice Bureaux which shows that charges for health care can deter people from seeking treatment? It seems that about 750,000 people in England and Wales do not obtain their prescriptions because of the cost involved. Does the Secretary of State propose to do something about that problem of access, based on lack of funds? [Interruption.]

John Reid: My hon. Friend the Minister of State says that £450 million is currently being spent on subsidising prescriptions. We introduced free eye tests for pensioners as well, of course. We have done a number of things, but we are always trying to do more for pensioners.
	A Liberal Democrat laughs. We introduced a guaranteed minimum pension. We introduced a fuel allowance. Three years ago, we introduced—[Interruption.]

Mr. Deputy Speaker: Order.

John Reid: I am only responding to a point, Mr. Deputy Speaker.

Mr. Deputy Speaker: I understand the Secretary of State's dilemma, but I should be grateful if he did not follow these red herrings.

John Reid: I shall try to avoid what you describe as red herrings on the Opposition Benches, Mr. Deputy Speaker. Let me return to the principles espoused by the Bill and, indeed, the national health service.

Chris Grayling: Talk about the Bill!

John Reid: The hon. Gentleman suggests that I talk about the Bill and not about the values and principles behind it. Let me explain this to him. When we bring a Bill to the House, we do not pluck it out of the air; we do not kneel down and adore it because it has been there for 30 years. It is based on a set of principles and a set of values. The hon. Gentleman may consider the words "values" and "principles" entirely alien to his political philosophy, but they are quite important to us. If I share them with the House and he agrees with the principle, no doubt he will find himself in the same Lobby as us.
	The hon. Gentleman will recognise the first principle: that the dividing line between those who support the national health service and those who oppose it lies in the belief that health care should be provided equally to those who need it, free at the point of need. That principle has been approved by the British people for 60 years, and has been supported by them ever since. I understand that changes such as the introduction of foundation trusts are often controversial, and that we must continue the discussions to carry people with us on such radical proposals. I would point out, however, that the new Commission for Healthcare Audit and Inspection will be able to audit and inspect all hospitals—not just foundation trusts and not only other hospitals, but all hospitals in the public and the private sectors. NHS foundation trusts will operate totally within that principle.

Chris Grayling: Will the Secretary of State give way?

John Reid: I want to make some progress. The hon. Gentleman has spent the last 10 minutes shouting "Get on to the Bill"; now he interrupts me when I am doing that.
	Our Bill proposes, in effect, a new form of local public ownership, guaranteeing equally high-quality service to patients that is free at the point of need. It has never surprised me that when we introduce such novel forms of local public ownership we encounter resistance from the Conservatives: that is entirely in keeping with their beliefs. They oppose anything that smacks of communal or public ownership. Whatever differences we have, however, I accept that my own colleagues find that difficult. I will not hide my disappointment that some of them felt the need to join the Conservatives in the Lobbies tonight, but I hope we can continue to talk it through. Because this is a new and radical form of public ownership, there will be problems that we shall have to work out; but I genuinely believe that this is one way in which we can ensure that we revitalise the NHS in a way that is in keeping with its principles, and at the same time allow local decision-making—which is possible and, indeed, necessary—to meet the different needs and expectations of 60 million of our fellow countrymen.

Michael Weir: Will the Secretary of State give way?

John Reid: I will, only because tonight the SNP set a precedent that it said it never would, and came down en bloc to vote—unfortunately—against improvements in the NHS.

Michael Weir: It is interesting that the Secretary of State should make that point, because that was not why we voted. It was because of the Barnett consequentials, as he should know.
	The Secretary of State has said a lot about foundation hospitals. Although I do not agree with it, I understand why someone might want foundation hospitals in both Scotland and England, but can the Secretary of State explain why some Scottish Labour Members seem to favour foundation hospitals in England but not back in Scotland? Is that not an inconsistency?

John Reid: I am sure that those who voted tonight—and some Scots voted against the Bill, including the hon. Gentleman and his colleagues and some on our side, as well as Scottish Liberals, although others voted for it—hold the same views whether they vote here or voice their opinions in Scotland.
	Of course we believe in devolution in this House. Part of the deal, which we as a Labour Government put before the people and brought to the House, was the simple proposition that all Members are equal in terms of voting rights and of their opportunities to hold office. Not only is that right in principle; to go in the direction in which the hon. Gentleman wishes to go would bring chaos. There would have to be different voting regulations, and opportunities for ministerial office would have to be different for the Scots, the Welsh and those in Northern Ireland. [Interruption.] The hon. Gentleman says, "Yes". That is three categories. Then there are London Members, because we devolved the executive control of transport. Then there is the north-west of England and the north-east, if they opt for regional government. We would end up with eight classes of MPs. That is a recipe for chaos. We have never accepted that.

Alex Salmond: Will the Secretary of State give way?

John Reid: I will give way to the hon. Gentleman, as he has made the effort to come down—even if it was to vote against the national health service.

Alex Salmond: As the Secretary of State should be aware, there are huge implications for funding in Scotland if foundation hospitals, via the Barnett formula, go ahead in England; however, he has not answered the point made by my hon. Friend the Member for Angus (Mr. Weir). How can Scottish Labour Members be in favour of foundation hospitals in England, given that the Labour party policy in Scotland is against them? How can Labour Members in Scotland simultaneously hold the positions of being in favour of them south of the border and against them north of the border?

John Reid: The answer is the same as the one that I gave earlier. What the hon. Gentleman is saying is not true—there is a thing called devolution. The Labour party is slightly bigger than the hon. Gentleman's own party. We draw our members from a much wider base, whereas his party is confined to one country—as, incidentally, is the Tory party. Indeed, if the Tories are not careful, they will be overtaken by the SNP. For those of us who belong to a party that is truly represented throughout Britain—

Mark Francois: Will the right hon. Gentleman give way?

John Reid: I am afraid that I genuinely cannot. I have already taken a long time, and I want to get to some of the meat. We believe in devolution. We believe that there is no one-size-fits-all solution for Britain, and nor is there a one-size-fits-all solution for the national health service. That is why we are decentralising power.
	The second principle is that the value of the national health service is defined around patients, not around the needs of providers. Yes, I have the greatest respect for politicians—for those who provide the decisions, the policy and the money—for those who work in the national health service, for those who lay the bricks and build the buildings, for those who make the tea, and, indeed, for those who make the surgical incisions. But ultimately, this is not about the providers; it is about the patient, and the patient must be the arbiter of everything that we do and the benchmark of our success. Again, that leads to striking difficult balances and making difficult choices, but Labour Members have never been frightened to do that.

Graham Allen: Will my right hon. Friend give way?

John Reid: I shall give way one more time.

Graham Allen: The whole foundation hospitals episode has been bruising for everybody on the Labour Benches, regardless of which side of the argument they are on. Many of us remember my right hon. Friend's pugnacity as Leader of the House and as chairman of the Labour party, but some of us also remember the skill that he brought to bear in Northern Ireland and in the former Department for the Environment, Transport and the Regions. Will he make every effort to ensure that those who have made honest representations on this issue are still part of the family of people whom he will consult and maintain very close links with as we rebuild the health service?

John Reid: The answer to that is yes, yes and yes again, because I genuinely believe that the commitment on the Labour Benches to the values of the national health service is such that it overcomes, and should overcome, any differences in terms of exactly how we get that system operating and how we enshrine those values.
	The third point is that the Bill enshrines true security and equity for our people. That was built in as one of the objectives of the early health system, but to be truthful, it has never been delivered in the light of the sheer uniformity of production of service. The truth is that choice, in terms of meeting the ambitions of our people through the decades, will remain theoretical rather than real unless sufficient capacity is injected into the NHS itself. I am not one of those who think that this is a question of choosing between increasing capacity and increasing choice; the truth is that both are necessary. If we do not increase capacity, we cannot give the patients themselves true choice; and if we do not give them true choice, we will not maximise the focus, direction and use of the extra capacity that we are putting into the health service—a point that also relates to the question of fairness.
	As has been pointed out, we have listened to the various concerns that have been expressed about the Bill. For instance, we have introduced measures to cap the amount of private work that an NHS foundation trust can do, introduced local accountability and ensured common application of the terms and conditions agreed under "Agenda for Change". So in the teeth of opposition from the Conservatives, we have tried to listen, but above all we have tried to make real progress for the national health service. I believe that NHS foundation trusts will help us to take a further great stride forward for patients. And when we do so—when we make decisions about the systems, processes and structures through which we are trying to enshrine our values—Labour Members will never forget, I hope, that the choice is now clear.
	The real dividing lines are opening up on this great issue of health care. After six decades of post-war consensus, there is now a breach in that consensus. The choice, which is enshrined in this Bill, is between reforming the NHS or breaking it up; between mending it or ending it; between massive investment or savage cuts; between modernisation or privatisation; and between increased spending or increased charging. It is a choice between our promise to provide the systems to run alongside the training of doctors and nurses, the building of skills in hospitals and the provision of teachers and skills, thereby building on the Bill itself; or the Tory pledge card, of which the hon. Member for Woodspring (Dr. Fox) is the architect and proud parent. That pledge card outlines their aims: to cut public spending, to sack nurses and doctors, to axe hospitals and to transfer money away from the NHS and into private care.
	When I consider that choice—between a Labour party that believes in health care free at the point of need, and a Tory party that now apparently believes that when someone is ill, the health service should take their money before taking their temperature and feel their wallet before feeling their pulse—all I can say is, "Roll on the general election." Meanwhile, I commend the Bill to the House.

Liam Fox: To end with an utterly fatuous analysis of the difference between the parties and to create demons that do not exist, thereby frightening the sick and vulnerable, is unworthy even of a Secretary of State thrown into the job unwittingly in a botched reshuffle by a Prime Minister who had the poor sense to put in charge of health care in England someone who does not have to take responsibility for any of his actions in respect of his own constituents in Scotland. I am also saddened that the Secretary of State made his debut on this subject tonight by barely mentioning the Bill at any point in his speech. Instead, he gave us a lecture about some strange and bizarre version of history and his party philosophy. He preferred that to facing his Back-Bench colleagues head on in the difficult debate on foundation hospitals. If the Secretary of State does not have the courage to do so, the Opposition cannot be held to account for it, but it is a great pity.
	We should remind the Secretary of State of a couple of things. When it comes to the post-war consensus on the national health service, which he says has been maintained up to this point by all Governments, it is worth pointing out that in the post-war period since the NHS was created, it has been maintained for 35 years by a Conservative Government and for only 17 by a Labour Government. I would have thought that that speaks for itself.
	The Secretary of State spoke rather patronisingly—and the Minister of State insultingly earlier—to his own Back Benchers, accusing them of going into the Lobby with the Tories tonight. I had better point out that it was a Labour amendment, not one of our amendments, on which the Conservatives chose to go into the Lobby with his hon. Friends. The Secretary of State needs to learn not to insult his own side as often as he seems intent on doing.
	One could not have gleaned it from listening to the Secretary of State, but there are three main elements in the Bill—foundation hospitals, the CHAI and its reform to provide a new system of inspection, and of course the GP contract, which is essential to changes in primary care, though it was not mentioned once in the Secretary of State's Third Reading speech on his own Bill. That speaks volumes about the Government's approach to primary care.

John Reid: The hon. Gentleman said that there were three main elements, but he has just mentioned four.

Liam Fox: No.

John Reid: Does the hon. Gentleman want me to elaborate them?

Liam Fox: The Secretary of State needs a little lesson, because the GP contract is primary care. I know that he is not au fait with the terminology of his new job yet, but most of us regard general practice as one of the essential parts of primary care. Perhaps the Secretary of State should ask the Minister of State for some advice on the language of the NHS in England.

John Reid: rose—

Mr. Deputy Speaker: Order. All I insist on is that we do not have two Front-Bench Members on their feet at the same time.

Liam Fox: I am sure that the Secretary of State will learn in time, and I will not hold it against him.

John Reid: Will the hon. Gentleman give way?

Liam Fox: No, we are not accepting plea bargaining tonight.
	We need to assess the basic elements one by one. On foundation hospitals, we do not have a problem with the concept. Indeed, we are keen on the model of foundation hospitals in other countries—Sweden, for example. Swedish hospitals have freedom to borrow according to their own plans and in terms of their own investment needs; they have freedom from political interference in setting targets and freedom to set their own pay and conditions. The Secretary of State described us as scuttling around Europe, as if we in Britain had nothing to learn from other countries in Europe, many of which provide better health care than we do in the United Kingdom. If we examine countries such as Germany, we find that they have far better quality care than is received by poorer groups in the United Kingdom. We have much to learn from the social insurance model in other parts of Europe.
	We could have argued today that we were in favour of the move closer to the internal market and the potential proto-legislation that Labour has introduced, because such are the secondary powers in the Bill that an incoming Conservative Government could move much faster towards the sort of model that we would like to see, without having to introduce primary legislation. However, we laid out the reasons why we were unhappy with the Bill as regards foundation hospitals, and why we supported the relevant amendment earlier. I shall elaborate on those reasons.

Jon Owen Jones: On the subject of the lessons learned from Europe, is the hon. Gentleman familiar with the processes, currently going through European courts and our courts, that will determine the rights of European Union citizens to access health services in any other European state? Those will have profound implications for the development of the health service. Does the Tory party agree that British citizens should have the right to access services in any other EU state?

Liam Fox: I know that to answer that question would be to stray on to the issue of European legislation, and therefore you might not approve, Mr. Deputy Speaker. However, if we are to have such rights, they should be genuinely reciprocal. For example, British patients in France should be treated as French patients would be treated in this country—in other words, free at the point of use. At the moment, British patients go to France but have to pay, but the French can come to Britain and be treated free. We should have genuine reciprocal rights, not the loaded dice that we have at present.

Graham Allen: Will the hon. Gentleman give way on that point?

Liam Fox: No, I am not going to be tempted further on Europe. We need to make progress on discussing the Bill, because we have only an hour to do so, courtesy of the Government's timetable.
	What do we see when we compare the freedoms of foundation hospitals in other countries with what we will have here? Here, we see borrowing curtailed by the Treasury. In fact, it is worse than that, because any borrowing will be curtailed within a single envelope. Any foundation hospital that is able to access more money will do so at the expense of other hospitals. That is a recipe for what Labour Members have called a two-tier system. The whole point of being able to borrow outside Government limits is to be able to raise expenditure without affecting the resources available to others in the publicly funded sector. However, the Government fail to understand that. The freedoms will be rolled out for only a few hospitals, rather than as a programme for all of them, and that is a recipe for maximum instability in the system.
	On the issue of the regulator, the Minister of State told us that the Government had taken increasing measures throughout the passage of the Bill to guarantee the independence of the regulator. What sort of independence is it when the regulator will be hired by the Secretary of State, fired by the Secretary of State, has his rates of pay set by the Secretary of State, and cannot give agreement to a foundation hospital unless it has first been agreed by the Secretary of State?
	We did not receive sufficient explanation of several areas of the Bill in the debates earlier today. We asked, frequently, about pay and conditions. What freedoms will foundation hospitals have to alter pay and conditions that other hospitals will not have? If foundation hospitals will not have those freedoms, what is the point of the exercise? If they will have those freedoms, they need to be defined at the outset. How will those freedoms impact on the Chancellor's regional pay strategy and on the Prime Minister's pledge to uprate above inflation? How will all those factors affect the pay rates of foundation hospitals?

Several hon. Members: rose—

Liam Fox: I shall give way to the hon. Member for Nottingham, North (Mr. Allen) and then to my hon. Friend the Member for South Cambridgeshire (Mr. Lansley).

Graham Allen: On freedoms and the ability of hospitals to set their own parameters, I assume that the hon. Gentleman refers also to the freedom of individuals to be charged £5,000 for a hip replacement or £9,000 for a heart bypass under the Conservatives' passport scheme. He mentioned looking to Scandinavia, including Finland, but is that giving another meaning to the phrase "finish the NHS"?

Liam Fox: I shall give way to my hon. Friend the Member for South Cambridgeshire (Mr. Lansley), who will talk a good deal more sense.

Andrew Lansley: My hon. Friend was talking about the role of the independent regulator. We only really understood in Standing Committee that the regulator is going to have to exercise his functions in a way that is consistent with the performance of the duties of the Secretary of State under the 1977 Act. As the Minister admitted in Committee, that means that the Secretary of State will be able to issue guidance to the independent regulator on the exercise of all his functions.

Liam Fox: I imagine that this is plumb in line with the previous Secretary of State's well known way of running the health service along the lines of earned autonomy, which meant, "You can do whatever you want, as long as it's what I want". This is the same doctrine, and it is now being extended to the independent regulator, who could not possibly be regarded as independent in any normal sense.

Graham Allen: Will the hon. Gentleman give way?

Liam Fox: I am certainly not going to give way to the hon. Gentleman, who is wasting his time as much as he is wasting mine. I can tell him things, but I cannot understand them for him.
	One of the most contentious areas of our debate today, and throughout the passage of the Bill, has been the question of governance.

Graham Allen: On a point of order, Mr. Deputy Speaker. Is it not one of the normal courtesies of the House for a Front Bencher to respond when an intervention is made?

Mr. Deputy Speaker: That is not a point of order for the Chair, and I have to say that there comes a point at which attempts to intervene simply interrupt the debate in a quite irrational way.

Liam Fox: Yes, Mr. Deputy Speaker, especially from someone who has taken no part in the passage of the Bill up to this point.
	It is interesting that the question of governance caused the most trouble on the Government's Back Benches. We got no answer to many of our questions on this issue. What is the logic of having an electoral system for the providers, but not for the commissioners, of care? Several Labour Back Benchers asked today how this provision would impact on their constituencies. People will have no ability to change the basis on which services are configured, because that configuration will be dependent on the allocation of resources. To establish electoral formats for the providers will therefore make no difference whatever.
	The Secretary of State says that this is all about public ownership, but I always thought that the national health service was in public ownership, so why we have to redo it is quite beyond me. What are the great constituencies going to be? In relation to the regional and national hospitals, we are still waiting for an answer on who the voters are going to be, what the constituencies are going to be, and what the cost is going to be. Not once have Ministers denied our indicative figure of up to £250,000 per trust per year, simply to run the system. The Government say that they are decentralising and cutting red tape and bureaucracy, but they are creating a whole new tier of bureaucracy and red tape, in which hospital managers will be more concerned with running elections than with running hospitals. This is a disaster in the making.
	The Secretary of State talked about what the Government were doing on capping private health care. That was one of the most profoundly dishonest parts of the passage of the Bill, because the Government have changed the provisions in the Bill on capping private income from "must" to "may". They state that the power is to be exercised
	"with a view to securing that . . . proportion of the total income",
	but they have done nothing finally to cap it.
	On CHAI, we have argued since the first Government Bill when they came to office in 1997 that there should be a single regulator across all parts of health care, regulating on the basis of the patient's experience and not according to who the provider is. The Government have belatedly caught up with us on this issue, and we welcome that.
	Part of the Bill that has changed since Second Reading is the section relating to the GP contract, and this makes a profound difference to the Bill as a whole. I should perhaps declare an interest as a member of the Royal College of General Practitioners. Following substantial negotiations between the BMA and the NHS Confederation, and the overwhelming vote—an absolute majority—by GPs that this is what they want, it is clear that this is the model of health care that we will take forward. It is unfortunate that we did not have more time to discuss these matters in the House of Commons, but we shall certainly have plenty of time to consider them in detail in the House of Lords.
	The Prime Minister said that the Bill was of historic importance. It is historic—it is an historic waste of opportunity. The Government will have to come back and remedy it, because it is deeply flawed and was made up as they went along. It therefore gets the worst of both worlds—it has the worst possible financial framework, and that fault is augmented by Whitehall control. It truly is a wasted opportunity that the Government will live to regret.

Kate Hoey: I am pleased to have caught your eye, Mr. Deputy Speaker. I spent eight hours in the Chamber on Second Reading and all of today without being able to express my views, despite having two trusts with three stars in my constituency. I would like to put on record my reasons for opposing the setting-up of foundation trusts and not backing Third Reading, despite the fact that I support certain aspects of the Bill.
	I am disappointed that the Secretary of State did not choose to answer some of the many serious criticisms made by many hon. Members about foundation hospitals. I would like to remind the House that, according to the Secretary of State, the fundamental reason for establishing foundation hospitals is to improve the care of patients. Since Second Reading, I have spent a lot of time talking to my hospitals, local people and the PCT, and have yet to meet anyone who can come up with a single reason as to why a foundation hospital trust will achieve concrete improvements to patient services. It is important that we look at all the proposals in the Bill that could have been carried out simply by amending existing measures. We talk about democratisation of governance, and want local authorities to get involved, but that could have been done by amendment.
	Trying to achieve a supposed democracy by involving local people will be a nightmare, and will cost far too much. I cannot justify the spending of thousands of pounds by hospitals in my constituency. Kings College hospital and Guy's and St. Thomas's hospitals will all compete for the same membership, with the exception of people who go for treatment at national centres at St. Thomas's and Guy's, not to mention the huge numbers of MPs who are always popping over to St. Thomas's. Presumably they will all be able to pay their money and become members of trusts. I cannot justify the spending of that money to establish an electoral process that will stand up to legal scrutiny—it is just nonsense.
	No one in my constituency accepts the need for that kind of artificial democracy, as the hospitals already offer patients forums. St. Thomas's, in particular, reaches out to people in the area with pensioners forums—pensioners go to the hospital to discuss their needs, such as home helps and many other things. There is no need for this supposed democracy, which will not make the slightest difference, because the money is held by the PCTs, which are undemocratic. The whole thing is therefore nonsense.
	Hospitals will supposedly be able to borrow more than they can at the moment, but they will have to pay it back. I am worried about what will happen if they run into difficulties. At the moment, if they decide to sell an asset, they have to offer it first to other hospitals and keep it within the NHS but, under the new arrangements, as soon as they get into trouble there will be asset stripping. I shall be brief, as other hon. Members wish to speak. I am all in favour of taking power away from Whitehall and giving it to local hospitals, but we do not need to create foundation hospitals to do so. All the problems that hospitals experience with bureaucracy and paper-chasing could be solved, as my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) said, by the Secretary of State simply saying that things are not going be done that way. This is a complete distraction and diversion, and it comes just as hospitals are beginning to see the benefits of the money that the Government have put in. It takes a long time for the benefits to come through but that is beginning to happen. However, we are completely diverting everyone in the trusts and setting them to work on establishing foundation hospitals.
	Officials from the Department of Health are on the telephone and sending e-mails almost every day to the trusts, asking what people there think that they should do about foundation hospitals. The Department cannot answer a single question about the practicalities of how the system will work. Resources will be taken away from those in our health service and hospitals who should be working to improve matters for patients. The proposal is a diversion and a distraction. It was not in the manifesto, and I feel no compunction whatsoever about opposing my Government today.

Evan Harris: Second Reading was held some time ago and was kicked off by the right hon. Member for Darlington (Mr. Milburn). It is appropriate to pay tribute to his work on the Bill, flawed though the proposals are. There is no doubt that he was a very able Minister and Secretary of State. It is unfortunate that personal circumstances should have prevented him from seeing the Bill through to this stage.
	I wish the new Secretary of State well. I recognise that, despite the qualifications held by me and the hon. Member for Woodspring (Dr. Fox), he is the only proper doctor among the three of us. I tell that to my constituents on a regular basis. However, when questions are raised on specific policies, I hope that he will resist the temptation that his predecessor could not always resist—that is, to impugn the motives of others and to launch half-hearted and supposedly humorous personal attacks on those who do not agree with him.
	Liberal Democrat Members, and even sometimes Conservative Members, ask reasonable questions that deserve to be answered, on Second or Third Reading. It is unfortunate when every question about the Government's policy draws as a response an attack on the policies of Opposition parties. That may be tempting but, if there is a time and place for such a response, it must come after questions about Government policy have been addressed.
	The Secretary of State said several times that he is committed to an NHS that is universal and comprehensive, free at the point of delivery and in which treatment is based on clinical need, not the ability to pay. I do not doubt his sincerity about wanting to support an NHS like that, as that is the NHS that I support. However, I recognise that the NHS that we have at the moment—even before it is subject to the policies of any other party—is not universal or comprehensive.
	We have to accept that rationing exists in the NHS, and recognise that the best thing that we can do is hope to limit rationing by putting in the necessary resources. I voted for the Government to do that. They have done it—belatedly, but they have done it. In addition, we must make sure that what rationing there is is made explicit. In that way, people will know the consequences of voting for tax cuts and for cutting resources for the NHS.
	I do not doubt that the Secretary of State wants the NHS to be free at the point of delivery. However, he must recognise that it is not always free at the point of delivery. In dental care, for example, 84 per cent. of people, even including those of pensionable age, are not exempt from contributing to NHS dental charges, which can amount to as much as 80 per cent. of a maximum of £366. Also, hundreds of thousands of people, even those with chronic diseases, are prevented from getting their prescriptions because of prescription charging. For them, the NHS is not free at the point of delivery. The Government should have greater aspirations even than those contained in the Bill, as they would see it, to establish an NHS that is truly free at the point of delivery.
	The Secretary of State would also argue that treatment should be based on clinical need and not the ability to pay. I hope that he recognises that the amount of NHS capacity reserved for paying patients means that, at a time when capacity is limited, there are thousands of people whose clinical need is greater than that of those in the pay beds. However, those NHS beds are occupied by people who have jumped the queue because they can pay. As the Select Committee said, the Government should do something about pay beds.
	The Bill has five parts. One part, which has received less attention than it deserves, contains the proposals for the quality inspection regime—the Commission for Healthcare Audit and Inspection, and its sister body covering social care inspection. The Bill is a disaster for the independence of both bodies, which will become the Government's creatures, charged by the Government to implement Government policy. The Bill even contains a clause that states that the commission "shall have regard" to Government policy. The target regime and the so-called standards regime will clearly be seen to be political. The Commission for Healthcare Audit and Inspection will be far less independent even than the Commission for Health Improvement. I do not think that the NHS will have confidence in it.
	Another part of the Bill deals with the recovery of charges from employers where they are liable. Even that has had to be postponed because the Department for Work and Pensions requires a review of its impact on small businesses.
	The GP contract may be good for GPs; I do not blame them for voting for it. At best, however, it will mean no change for patients and, at worst, it will be worse for them. The contract provides neither more GPs nor more GP time; it merely allows GPs to opt out of providing holistic care on a one-stop-shop basis.
	My hon. Friend the Member for Cheadle (Mrs. Calton), to whom I pay tribute, has drawn attention to the great deficiencies in the welfare food scheme. Many of the provisions should not and will not survive the Bill's passage through the House of Lords.
	The Government majority of only 35 on the foundation hospitals proposals shows that their policy is wounded as the Bill limps to the Lords. The policy is unloved by staff; the unions and professional staff oppose it. It is unloved by patient groups; they know that the priority should not be to set hospital against hospital. We oppose it. Many of the Government's Back Benchers oppose it, including at least six former Ministers. The policy is loved only by the Tories, but not so much that they could not vote against it. The House of Lords should put the policy out of its misery so that the NHS can concentrate on providing the freedoms required to empower commissioners and to put patients' needs first. We should have an inspectorate free from political control.
	For all those reasons, we shall oppose Third Reading and we urge hon. Members on both sides of the House to join us in so doing.

Howard Stoate: I realise that time is short but as I am the only practising GP in the House, I feel qualified to make one or two points that may, I hope, help hon. Members.
	My constituents believe passionately in the NHS. They believe in a service free at the point of use and available to all, regardless of their circumstances. The only alternative to a national health service is some sort of privatised service, based on social insurance or a private insurance scheme, neither of which would cut much ice with people in this country.
	People tell me that one of the current problems is that the service is too often geared to the needs of the providers and not enough to the needs of the users. They want more choice, more flexibility and more say in how their services are run.
	There has been a huge, long debate on foundation hospitals, but it boils down to a simple concept, which is not rocket science and does not involve destroying the health service or huge upheaval. The proposals would do two things: first, they would give more democracy to the health service by setting up boards of governors whereby local people can have an important say in the way that the health service is run.

David Taylor: Will my hon. Friend give way?

Howard Stoate: I am very short of time.
	People on the board of governors can say how the hospital is run. People would also have the opportunity to decide for themselves how services are provided, dependent on local needs, priorities and circumstances. Surely, that is the way to go. It is merely opening up the health service, to provide more flexibility, more choice and more democracy.
	It is difficult to understand what all the fuss is about. The proposals are a way of improving the health service to deliver the health care that we need in the next century. The NHS is 60 years old, and it is ripe for modernisation. We need a service that is more responsive to users and less geared to the needs of providers.
	I realise that there is little time to develop the debate, but those points are important. The new GP contract will also be of huge benefit to patients because it will allow GPs to provide a much more responsive service and to meet as many needs as possible in a health service of which we should all be proud. I hope to be part of it as it develops.

Andrew Lansley: As the Bill goes off to another place, I urge those in that place to reform it so that primary care trusts and commissioning are at the heart of local ownership, that if there is to be an independent regulator, he should—
	It being eight hours after the commencement of proceedings on the programme motion, Mr. Deputy Speaker, pursuant to Order [this day], put forthwith the question already proposed from the Chair.

Question put, That the Bill be now read the Third time:—
	The House divided: Ayes 306, Noes 57.

Question accordingly agreed to.
	Bill read the Third time, and passed.

BUSINESS OF THE HOUSE

Motion made, and Question put forthwith, pursuant to Standing Order No. 15 (Exempted business),
	That, at this day's sitting, proceedings on consideration of Lords Amendments to the Railways and Transport Safety Bill and the Licensing Bill [Lords] may be proceeded with, though opposed, until any hour.—[Mr. Heppell.]
	Question agreed to.

RAILWAYS AND TRANSPORT SAFETY BILL (PROGRAMME) (NO. 2)

Motion made, and Question put forthwith, pursuant to Orders [28 June 2001 and 29 October 2002],
	That the following provisions shall apply to the Railways and Transport Safety Bill for the purpose of supplementing the Order of 28th January 2003—
	[Consideration of Lords Message]
	1. Proceedings on consideration of the Lords Message shall (so far as not previously concluded) be brought to a conclusion one hour after their commencement.
	[Subsequent stages]
	2. Any further message from the Lords may be considered forthwith without any Question put.
	3. Proceedings on any further Message from the Lords shall (so far as not previously concluded) be brought to a conclusion one hour after their commencement.—[Mr. Heppell.]
	Question agreed to.

Railways and Transport Safety Bill

Lords amendments considered.

After Clause 27

Lords amendment: No. 1, to insert a new clause—Exercise of powers by civilians.

Tony McNulty: I beg to move, That this House agrees with the Lords in the said amendment.

Mr. Deputy Speaker: With this it will be convenient to discuss the following: Lords amendments Nos. 2 to 9 and 10, and the Government motion to disagree thereto, and Government amendment (a) in lieu thereof, and Lords amendments Nos. 11 and 12.

Tony McNulty: The amendments are the result of productive and substantive debate in the other place—[Interruption.]

Mr. Deputy Speaker: Order. May I ask hon. Members who are not staying in the Chamber for the debate to leave quickly and quietly?

Tony McNulty: It might be useful if I go through the amendments in some detail, although not necessarily at length.
	Lords amendments Nos. 1 and 3 will essentially give the British Transport police the powers to deploy community support officers and investigation, detention and escort officers. The provisions will bring the British Transport police fully in line with Home Office police regarding such civilian officers.
	Lords amendments Nos. 2 and 8 were tabled in response to recommendations made by the Delegated Powers and Regulatory Reform Committee in another place. They will provide that any changes to the upper and lower limits on the number of people on the British Transport Police authority would be subject to the negative procedure, and that the affirmative procedure would be used the first time that the Health and Safety Executive rail levy was introduced.
	Amendments Nos. 9, 11 and 12 add to existing police powers to test for alcohol use on the roads by allowing them to administer a test for impairment and for the presence of drugs by means of a sample of saliva or sweat. Amendments Nos. 4 to 7 introduce equivalent police powers for the aviation and maritime sector. That is all that the amendments do, and I commend them to the House. They were discussed, to varying degrees, in the other place, and the Government made the commitment to table amendments in lieu of those suggested by the Lords if necessary.
	The only difficulty we have is with Lords amendment No. 10 and the Government offer a replacement in lieu. When the issue was discussed in another place, we made it clear that we could not accept Lords amendment No. 10, for a variety of reasons. In essence, it deals with the regulation of motor vehicles on the Ridgeway. Many local Members and some local authorities have tried to get some order in the use of motor vehicles on the Ridgeway. I want to say, apropos of nothing at all, that I had great fun when I was about 16, spending a week walking from one end of the Ridgeway to the other, eating horrible powdered meals in the evening— I was too young for the pub—and putting up tents.

Don Foster: I am sure that entire House is delighted to know that the Minister experienced the great delights of the nearly 1,000-year-old Ridgeway. One hopes he is about to say that he, too, is disturbed by the large number of motorised vehicles that now use it. However, will he acknowledge that Government amendment (a) uses the word "may" instead of "shall"? The House will worry whether the Government have a clear intention to act on the problem, or whether their amendment is merely a sop to another place. Will the Minister assure us that they intend to take action?

Tony McNulty: I would never appear at the Dispatch Box and offer sops to anyone—the official Opposition, the minor Opposition or Members of the other place. We intend to take action, save for two features. We want to discover whether the Countryside Agency's management plan produces results within the next 12 months. Over that time, we want to work far more closely with local authorities, which are at various stages of their management schemes, while working with the Countryside Agency. I can assure the hon. Gentleman that if the Countryside Agency's management plan and the work of local authorities do not produce results within 12 months, the Government are committed to consider promoting such a ban along the length of the Ridgeway.

Andrew Bennett: Will my hon. Friend remind the House how long the Countryside Agency has been dealing with the problem? It has been pretty pathetic.

Tony McNulty: It is not for me to comment on the efficacy or otherwise of particular agencies. The Department for Transport is working closely with the Department for Environment, Food and Rural Affairs. I will say as starkly as I can that the Countryside Agency is on notice for 12 months. The matter is of serious concern to many local authorities up and down the Ridgeway and to many hon. Members who represent parts of the Ridgeway or who believe it to be a splendid element of our heritage. If the agency does not deliver, the Government are committed to consider promoting a ban along the length of the Ridgeway rather than relying on the partial local traffic regulation orders.

Tim Collins: Let me first offer the Minister my congratulations on his recent promotion.
	On the difference between Lords amendment No. 10 and the alternative that the Minister proposes, in addition to the significant alteration mentioned by the hon. Member for Bath (Mr. Foster), the wording has also been changed. Rather than specifying national trails, the amendment in lieu specifies long distance routes. The Minister has related his remarks to the Ridgeway, which is at the heart of the matter, but it is not the only area affected by either of those amendments. Will he clarify the difference between national trails and long distance routes?

Tony McNulty: As I understand it—and if the position is other than this, I will get back to the hon. Gentleman—long distance means national trails of significant length, such as the Ridgeway. Unless I am mistaken, I do not think that there is much else in the country that would be captured by that definition, but I will check that.

Andrew Murrison: Can the Minister say whether the measure, which seems sensible, is compatible with the general drift of the Countryside and Rights of Way Act 2000, in particular the creation of "byways open to all traffic"? It seems that the general thrust of the Bill is rather different from that of the Act.

Tony McNulty: That is the sort of issue that we want to explore further with the Countryside Agency in the context of its management plan, rather than going from the present position, which everyone accepts is less than satisfactory, to a position where all sorts of legalistic difficulties arise, not least for the reason suggested by the hon. Gentleman. We believe it is worth taking some time to see whether the Countryside Agency plan beds in, but hon. Members should be assured that if it does not, we will address the matter.

Don Foster: I am grateful to the Minister for giving way a second time. It may save debate later. I, for one, am grateful for the assurance that he has given, but may I suggest that he needs to go a little further? He said that if the Countryside Agency did not deliver, the Government would commit to consider a ban. The House would be grateful if the Minister could give a slightly stronger assurance that, provided things do not go wrong, there is a clear commitment to introduce a ban if the Countryside Agency does not get its act together in the 12-month period.

Tony McNulty: That is what I am doing. I chose my words carefully, in lieu of the hon. Gentleman's proviso about things going wrong. If there is no satisfactory resolution of the matter within 12 months of the Countryside Agency's plan bedding in, and working with local authorities, some of which are far more advanced than others in taking these matters seriously, the Government will consider acting in the way that I suggested. Of course that is conditional. I have learned in this trade, for want of a better phrase, as from others, that I am not a mind-reader or a futurologist, and we need to attach some conditions.
	I take seriously the concerns suggested by the movers in the other place and have taken to heart much of what they said. If the agency and local authorities can deal with the matter, it is right and proper that they should do so, but the Government will take a strong interest in their ability and their actions, and will act in the fullness of time, if necessary. In that context, rather than accept Lords amendment No. 10, we offer the Government amendment in lieu. In the spirit of good will and consensus—

Tim Collins: I sensed that the Minister was bringing his remarks to a conclusion. I hope he will forgive me if I take him back briefly to the group of amendments that he touched on earlier, relating to the new provisions enabling the police to try to assess whether drivers and others are impaired by the use of drugs. He will know that one of the keys to that is the extent to which police officers are trained in sufficient numbers to conduct the high quality impairment tests that have been learned by a number of police officers from overseas experience.
	Can the hon. Gentleman say a word or two about the extent to which the Government are committed to expanding the pool of police officers who have that training, and whether the Government may consider introducing targets for chief constables to increase the number of their officers who have passed those tests?

Tony McNulty: With the smooth passage of the Bill, as we hope it will be, it follows that the amendments to which the hon. Gentleman refers—Nos. 4, 5, 6, 7, 9, 11 and 12 in part or in whole—require greater training and a widening of the pool of officers, otherwise those powers are not helpful. Whether targets are associated with them, with or without the endorsement of the chief constable, is a matter for others far better placed to deal with that than I. On the resource and training issue, those matters should follow. The hon. Gentleman makes a fair point.
	I commend the new clause that we propose in lieu of Lords amendment No. 10, which is the only minor matter on which we disagree. I have given the hon. Member for Bath (Mr. Foster) the assurances that he sought. I also commend to the House amendments Nos. 1 through 9, to use a crude Americanism, and amendments Nos. 11 and 12.

Tim Collins: I should like to begin by congratulating the Minister once again on his recent promotion.
	I reiterate that the Bill remains largely uncontroversial. It left this House as a very good Bill and it is coming back from the other place as an even better one. As the Minister perfectly reasonably pointed out, the vast majority of the amendments that we are considering have been tabled by the Government in response to representations made in the other place by members of other parties. In particular, I hope that he will join me in paying tribute to Lord Dixon-Smith, whose wish to improve the law in relation to drug-impaired people in charge of vehicles took shape in a private Member's Bill and then in amendments to this Bill. I am glad to say that the Government took away those amendments, improved them and made them technically feasible, and have now tabled them in a form that I suspect will command the support of hon. Members in all parts of the House.
	The Minister was good enough to tell me in response to an intervention that the Government recognise the need to step up the training of police officers who will be expected to implement the new provisions inserted into the Road Traffic Act 1988. As he will know, if the amendments are agreed to, they will affect the entirety of that Act, so it will be necessary for the police to undertake a considerable amount of training. He may be amused to know that, following my recent visit to Kendall police station in my constituency, there is in the archives of the esteemed journal, the Westmorland Gazette, a photograph of yours truly performing some of the impairment tests. I was able to demonstrate to the satisfaction at least of myself, the photographer and the police officer who were present that I was able to place my finger on my nose while standing on one foot without toppling over. That seemed to reassure at least some of those present that I was not, at least at that moment, impaired by the use of drugs, illegal or otherwise.
	I hope that the Minister will take away from our proceedings a strong indication that, as in the other place, there is a clear understanding in this House of the fact that drug-driving is as dangerous as drink-driving. Regrettably, it is a rapidly growing phenomenon in our society. Just as it is welcome that the incidence of drink-driving is falling, it is deeply worry that drug-driving is increasing.
	In addition to ensuring that the police are adequately trained in respect of the high-quality impairment tests that I believe have been pioneered in the United States, which no doubt could be improved in this country, I hope that the Minister will also take away from this debate the very strong wish—this is certainly the feeling on the Opposition Benches, but I am sure that it is shared much more widely—that the Government should, as a matter of priority, continue to press ahead with research to see whether it is possible to produce a machine that can provide as quick and clear an indication of whether someone is under the influence of drugs as the breathalyser does in respect of alcohol. For some time, that idea has been something of a holy grail for law enforcement agencies around the world. It is extremely difficult to produce technology that can provide an absolutely clear result, even in testing for a single known drug.
	The concept of a broad-spectrum machine that can test for a variety of different substances is, for the moment, extremely difficult. Given technological advances, however, its development might not be so difficult for ever. It would be helpful if the Minister could take that message away and say whether the Government are committing research to such issues, perhaps not purely on a national basis, as there may be a case for such work to be done on a European basis or an even wider international one.
	We welcome amendment No. 4 and associated amendments. They do not go quite as far as was originally intended in the private Member's Bill introduced by Lord Dixon-Smith, but they go a great deal further than the current law. When we initially discussed the Bill in this House, the common view among all the party spokesmen was that we should not allow the fact that we were taking forward a railway safety Bill to send out a signal that we were anything other than deeply concerned about road safety. In the light of that fact, we should commend the other place and congratulate it on the way in which the Bill has been improved there.
	The other place has done its traditional job of seeking to probe the Government's intentions in a number of respects. It also succeeded in clarifying exactly what the Government mean by various provisions. In that context, I very much welcome Lords amendment No. 1, which would extend to the British Transport police the provisions in the Police Reform Act 2002 that enable the recruitment and use of community support officers and investigation, detention and escort officers. I should be grateful if the Minister would confirm in writing that the amendment would make the British Transport police indistinguishable, in terms of their powers and functions, from a regular Home Office police force. One of the original purposes of the Bill was to regularise the handling of the British Transport police to ensure that they were equal to Home Office police forces in terms of status, standing, powers and resources. Will the Minister confirm that the amendment would have that effect?
	As the Minister said, the only point on which there may be a difference between us—certainly, there is a difference between what the other place has added to the Bill and the alternative wording that he is commending to the Commons—relates to his proposal to replace what could be described as new clause 108, inserted by the other place, with Government amendment (a). The hon. Member for Bath (Mr. Foster) rightly pointed out that the most significant change relates to replacing the word "shall" with the word "may". The Minister was able to give us some assurances on that. His comments were extremely welcome and were phrased with his characteristic candour and openness; they were a pleasure to hear.
	The Minister talked about the Bill's phraseology in relation to national trails and long-distance routes. I hope that he will forgive me if I press him a little further on that. There is no doubt, as he said, and as became clear in the deliberations in the other place, that the principal concern stems from those who are keen to preserve the Ridgeway, which is a very beautiful and important part of the English countryside. Many hon. Members represent, to a greater or lesser extent, beautiful parts of the English countryside. Some of those areas are already part of the national trails network. The area of the Yorkshire dales that forms part of Cumbria and is in my constituency is due to become part of the national trails network in the next couple of years. So far, that has not been proposed for the Lake District, which is also largely in my constituency.
	I hope that the Minister recognises that concern about the use of what the Lords amendment describes as
	"non-essential mechanically propelled vehicles"
	is not confined to those people who enjoy or live near to the Ridgeway, nor is it confined purely to people who use national trails or long-distance routes. I hope that the Minister will take away from our deliberations a clear message that, although the Government have made a welcome concession to those who are worried about the use of inappropriate mechanically propelled vehicles in some contexts, there would be an even wider welcome were they to indicate that that is part of a process of reviewing the entirety of the appropriateness of access of certain vehicles to certain parts of the countryside. In many parts of the countryside, routes that were designed only for pedestrians, or, at most, horses, and often involve ecologically fragile and valuable areas, are regularly churned up, not only by four-wheel-drive vehicles but by motorbikes and other inappropriate vehicles. I hope that the Government's amendment will send a signal not only to those who are worried about the Ridgeway but others that they intend to revert to the issue and perhaps devise a national framework for potential legislation. The matter was considered during the passage of the Countryside and Rights of Way Act 2000. It was not possible to legislate on it then, but I hope that the Government will examine the matter in detail.

Tony McNulty: I am told that "long-distance route" is the legal definition of national trails, which clearly include the Ridgeway. As I intended to make clear, the Ridgeway is the only long-distance route with significant rights of way for motorised vehicles. The assurance that I gave earlier would therefore cover specific anxieties about the Ridgeway. However, I believe that the same law would prevail if greater rights of way and greater access by motorised vehicles impinged on any other national trail or long-distance route.

Tim Collins: That is an exceptionally helpful clarification, which those who study our proceedings will read with interest. However, the Minister will acknowledge that his point simply reinforces mine: national trails are enormously significant routes but they are not the only important routes in the countryside. It would be helpful if the Government undertook to consider, in the context of national parks, whether some of the restrictions that they will examine—the Minister suggested earlier that they would seriously consider restrictions for national trails—should apply elsewhere.
	There is another difference between the wording of the Lords amendment and that of the Government amendment in lieu. The original amendment refers to a permanent order, and states:
	"The Secretary of State shall within one year from the coming into force of this enactment make a permanent Traffic Regulation Order".
	However, Government amendment (a) contains no reference to permanence. It provides for what the Secretary of State might do, but does not refer to permanence. I should be grateful for an explanation of why it is not necessary to retain the word "permanent".
	Will the Minister also consider whether it is wholly appropriate for such matters to be left purely to the Secretary of State's discretion? The amendment provides that the new clause will apply when the Secretary of State thinks that members of the public cannot safely and conveniently enjoy the amenities because of use of a long-distance route by vehicular traffic. When the matter was considered in the other place, Lord McIntosh, who spoke on behalf of the Government, suggested that the wording, for which another place subsequently voted and which has effectively become new clause 108, was defective. He believed that it might fall foul of the provisions of the European convention on human rights, because the wording made no provision for a right of appeal.
	That is an interesting and possibly valid point. However, if it is valid, its logic should apply to amendment (a). If the Bill needs to refer to appeal rights to ensure that it is covered by the constraints of the European convention on human rights, it would be helpful if the Minister could seek some guidance and offer an explanation. Clearly, we want to ensure that the final form of the Bill fully complies with our international obligations and that parts of it will not become subject to court action.
	It was curious that a Minister in another place believed it necessary to include a specific right of appeal in the Bill, given that the principle was not applied throughout the Countryside and Rights of Way Act 2000. Perhaps the Government have revised their view, but clarification would be helpful.

Andrew Bennett: It seems that this can be enforced by a traffic order. Is it not possible to appeal against a traffic order?

Tim Collins: The hon. Gentleman is right, but, as he will know, the original wording of the amendment—which was then new clause 108—also referred to a traffic regulation order, as defined in the Road Traffic Regulation Act 1984. My point is this: if a Minister in another place said that that was defective because it did not refer specifically to a right of appeal, how can the present wording be more satisfactory, given that it does not do so either?
	The new schedule consequent on the Government amendments includes an interesting reference, which has been mentioned to me by my hon. Friend the Member for Vale of York (Miss McIntosh). Incidentally, my hon. Friend apologises for not leading for the Opposition tonight, as she did with admirable aplomb in Committee, on Report and on Third Reading. That is because she was attending the Yorkshire Show, which for a Member representing a rural seat in the fine county of Yorkshire was a huge priority today. She did, however, do me a great service today by pointing out that there was considerable debate in Committee about the wording imported into the Government's new schedule. New section 6 (7) says:
	"A constable may administer a preliminary test"—
	that is, a preliminary test relating to drink and drugs—
	"only if he is in uniform."
	I can see that the Minister is thinking back to happy times in Committee.

Don Foster: The hon. Gentleman certainly missed out on the delights of the Committee's deliberations on this matter. As he was not present then, perhaps he will tell us now whether he thinks a policeman in uniform would be required to wear a helmet. I assure him that that was the subject of much debate in Committee.

Tim Collins: I am advised by my hon. Friend the Member for Vale of York, who had the enormous pleasure of attending every Committee sitting and hearing every speech made by the hon. Gentleman, that he was responsible for considerable debate about the presence or otherwise of a helmet. I am also advised by her not to allow myself to be—in her immortal words—"sucked into" that particular issue. I gather that it was a subject of some interest in Committee, and I look forward to rereading those sections of the debate.
	The issue in regard to the new schedule is whether the words
	"A constable may administer a preliminary test by virtue of any of subsections (2) to (4) only if he is in uniform"
	continue to make sense. We all understand that it is desirable for a police officer performing a test of this nature to be in uniform; the question is why it should be a prerequisite. Surely there may be circumstances in which it is not possible for a police officer to change out of plain clothes into a uniform, and he may not want the current physical condition of a suspect to alter during the time that it will take him to go back to the police station to change.
	Although the Minister was no more present in Committee than I was, I am sure that he has been briefed thoroughly by his officials. He will no doubt know that a number of outside organisations have expressed interest in the possibility of new tests involving mouth swabs. It might be established, through the application of various scientific techniques to samples of saliva, whether someone was over the drink or drugs limit. Perhaps, either later tonight or in correspondence, the Minister could clarify whether new section 6C in the new schedule indicates that the Government have revised the view that they expressed in Committee on the practicality and early availability of mouth swab tests on which criminal proceedings could satisfactorily rely.
	The amendments before us today are in large part the product of a Government who have for once listened. It is incumbent on Opposition Members to place on the record those unusual but none the less welcome occasions when the Government listen to representations. We should congratulate them and point out that in doing so, they have improved what was already good legislation. Although we continue to have some slight feeling that the original wording relating to national trails had much to commend it, we recognise that even on that matter, the Government have sought to address some important concerns. So I hope that before long, this Bill will become an Act—having at all stages enjoyed clear cross-party support—and that we in this House can together express the hope that those who will subsequently enforce its provisions can do so in the knowledge that they have the full support of all of the parties.

Don Foster: I begin by congratulating the Minister, the hon. Member for Harrow, East (Mr. McNulty) on his new post, and on the excellent way in which he introduced what is almost the final stage of our deliberations. I agree with the hon. Member for Westmorland and Lonsdale (Mr. Collins) that this is a very important Bill, the vast majority of whose measures have fortunately enjoyed cross-party support. The Minister was absolutely right to refer to the important role played by the other place, and to the productive and substantive debate that took place there. The hon. Member for Westmorland and Lonsdale is absolutely right to say that although the Bill was extremely good when it left this place, it has been improved even further as a result of those deliberations.
	Liberal Democrats welcome the amendments from the other place, and we are also conscious that the Bill has been improved not only by them, but by the fact that the Government have been given the opportunity to provide greater clarification of certain issues. For example, the whole House will welcome the fact that the debate in the other place clarified the question of the confidentiality of information given by witnesses to the rail accident investigation branch, about which there were some concerns. Great progress has been made as a result of those deliberations. Although the deliberations on the primacy of the rail accident investigation branch at the scene of an accident were not the subject of an amendment in the other place, they, too, were very helpful. However, further clarification is needed on that issue.
	I am also grateful to Baroness Scott, who introduced amendment No. 10—on national trails, or long-distance routes, as the Minister rightly describes them—in the other place. The Minister will be well aware that she enjoyed support throughout the other place for her proposal. Even though the Government will not accept her specific wording, she will be delighted to discover that the alternative amendment and the clear assurances given by the Minister tonight address the concerns that she and many others in the other place raised.
	Because I have not personally experienced walking the Ridgeway, I took the trouble to look it up on a website. It is quite interesting. It is Britain's oldest road, 137 km or 85 miles long,
	"much of it following the ancient chalk ridge route used by prehistoric man".
	The website also says:
	"The Ridgeway offers the chance to get away from the bustle of life in this busy part of England."
	The reality, however, emerged from the contribution to the Lords debate of Viscount Astor, a frequent walker of the Ridgeway, who said:
	"I declare an interest as I have done previously. I walk the Ridgeway most weekends. There is a voluntary code on the Ridgeway that bans cars and motorbikes at weekends. On Sunday morning, however, I was passed by 43 motorbikes all in a row."—[Official Report, House of Lords, 3 July 2003; Vol. 650, c. 1034.]
	That is hardly an example of getting away from the bustle of life as he had hoped.
	I am delighted that the Minister made it clear that the Countryside Agency is to be given a 12-month period to establish whether it can sort the matter out. In the event that it cannot—I am sure the whole House hopes that it can—it is clear, subject to the obvious caveats, that the Government intend to take action.

Tim Collins: Since the hon. Gentleman refers to the speech of my noble Friend Viscount Astor, I also invite him to comment on the fact that not one of the riders of the 43 motor bikes had a proper licence. Does that not suggest that there is further reason for the Government to act to restrict those who, sadly, seem determined to act irresponsibly in a beautiful part of our countryside?

Don Foster: The hon. Gentleman is absolutely right. If he has studied the Lords debate as assiduously as I have, he will know that the non-licensing of those vehicles was a matter of great concern, not least in respect of how they managed to get there in the first place. At some stage they would have had to travel on roads for which carrying a licence is an absolute requirement. Even if legislation is passed, we hope that, either through the Countryside Agency or in subsequent provisions, enforcement will be tackled as well.
	Several other amendments tabled in another place and accepted by the Government today—some were actually introduced by them—are welcome in bringing greater clarification to the Bill. However, when the Minister delivers his winding-up speech, will he explain more fully the purpose behind proposed new section 6B, on preliminary impairment tests? There has been some speculation in the media that it will tie in not only with drugs and alcohol testing but with the Government's new thinking on the requirements for older people who want to continue to drive motor vehicles. I hope that the Minister will briefly comment on that particular point.
	The hon. Member for Westmorland and Lonsdale referred to the holy grail—a test for drugs abuse equivalent to the breathalyser for alcohol abuse in driving vehicles. I draw his attention—and, more particularly, the Minister's—to the successful use in Sweden and America of the pupilometer, which might well prove to be, if not the holy grail itself, a useful precursor of a better system in due course. Have the Government given much thought to using that device?
	Several of the amendments before us are about road safety issues. The whole House will be aware that many anxieties were expressed during the passage of the Bill that it was unduly concerned with the issue of safety on modes of transport other than the road. I am sure that many people are delighted that, as a result of amendments here and in the other place, the issue of road safety began to come to the fore. Some of us were disappointed that the Government were not willing to live up to the commitment that they made in 1996, before they came to power, to lower the drug and alcohol limits. Nevertheless, we have seen some improvements.
	Perhaps the Minister will also comment on the Government's intention to introduce a road safety Bill in the near future. Notwithstanding the primacy in the Bill of the need to make some improvements in rail safety, almost all hon. Members would agree that our railways are already very safe indeed. Although since 1997 there have been some 17,000 deaths on the road, there have been fewer than 150 deaths on our railway. It is important to remember the high level of safety that already exists on our railways.
	We have some important amendments before us. They amend an already good Bill that has cross-party support, as the hon. Member for Westmorland and Lonsdale said. I am sure that tonight it will continue to receive that support for the additional amendments and for the assurance that we have been given on amendment No. 10 from the other place by the Minister tonight.

Tony McNulty: I welcome the tone as well as the substance of the debate. The hon. Member for Bath (Mr. Foster) said that the Bill has had cross-party support throughout, and I hope that it will reach Royal Assent with that consensus intact. I am sorry that I missed the Committee proceedings, because they sound delightful—unlike some of the Committees that I served on at the same time.
	I am more than happy to associate myself with the remarks by the hon. Members for Bath and for Westmorland and Lonsdale (Mr. Collins) about the individuals who played a good game in the other place. They include our own Lord Faulkner of Worcester and Lord Berkeley, Lord Bradshaw of the Liberal Democrats, and Lord Dixon-Smith, Baroness Scott and Viscount Astor for the Conservatives. They all had roles to play in the amendments that we have accepted fully or with modifications.
	Some issues remain outstanding, but I hope that they can be dealt with via correspondence and are not deal breakers that will hold up the Bill in the other place. As Hansard records, Lord McIntosh said in the other place that the original amendment No. 10 on national trails would fall foul of the European convention on human rights, because it would mean introducing a traffic regulation order without the right to a public inquiry and the chance to lodge objections, but not necessarily for reasons to do with the right of appeal. It is the chance to lodge objections that is missing. The Government amendment would allow the normal TRO process to be followed, so that it would comply with—I should not say "get round"—the ECHR, by allowing a public inquiry if necessary. I am assured that the Government amendment would also allow a permanent traffic regulation order, because that is contained in the body of prior legislation—whereas much of the amendment passed in the other place refers to, but does not make itself part of, previous legislation. The permanent route is something that the Secretary of State can decide.

Tony Baldry: I do not think that a single person in Oxfordshire believes that the issue of the Ridgeway will be resolved by voluntary agreement. The real concern is that a year will pass, nothing will happen and the matter will be kicked into touch. May I urge the Minister to start thinking about drafting legislation to address the issue, because that would concentrate people's minds. People in Oxfordshire feel very strongly about the issue.

Tony McNulty: I thank the hon. Gentleman for that intervention. Spurred on by the amendment in the other place, we now have the legislative hook to ensure that if those who can do something about the issue—the Countryside Agency and the local authorities—do not do so in the next 12 months, we can and shall. I urge the hon. Gentleman to read the report of the assurance that I gave earlier very carefully. Nowhere does kicking into touch figure in this process. I accept the real concerns expressed in the other place.
	I do not want to go over old ground in terms of areas that are outwith the amendments before us. I am sure that you would admonish me if I chose to do so, Madam Deputy Speaker. I can reassure the hon. Member for Bath that section 6B is not against older people. Its purpose is to detect the more instantaneous impairment brought about by drink and drug abuse, rather than ailments brought on by disability or age.
	I am told by the Under-Secretary of State for Transport, my hon. Friend the Member for Plymouth, Devonport (Mr. Jamieson) that I should not go down the swabs route, even though that subject was terribly interesting in Committee and is sure to run and run. Much of the technology involved, including the pupilometer that was mentioned earlier, is in its early stages and will have to be looked at in the context of making the drug impairment measures work properly.
	I have greatly appreciated the nature and tenor of the debate. This was a good Bill to begin with, and—as both the hon. Gentlemen have said—given our minor adjustments and the assurances made on amendment No. 10, it will leave here an even better Bill. I commend it to their lordships and hope that they will dispatch it on Thursday.
	Lords amendment agreed to.
	Lords amendments Nos. 2 to 9 agreed to.
	Lords amendment No. 10 disagreed to.
	Government amendment (a) in lieu of Lords amendment No. 10 agreed to.
	Lords amendments Nos. 11 and 12 agreed to.

Licensing Bill [Lords]

Lords message considered.

Schedule 1
	 — 
	Provision of Regulated Entertainment

Lords amendment: No. 62C.

Richard Caborn: I beg to move, That this House agrees with the Lords in the said amendment.

Madam Deputy Speaker: With this it will be convenient to discuss Lords amendments Nos. 62D to 62J and Lords amendment 62L in lieu of the words left out of the Bill by amendment No. 62.

Richard Caborn: I know that many Opposition Members will be extremely relieved that the fat lady is here to sing to us tonight. One thing that is certain is that she does not need a licence to sing in a royal palace. Thank goodness, too, that we can put paid to some of the daft ideas that have been buzzing round. It was suggested on the Floor of the House and in Committee that we would put postmen in jail if they whistled on their morning rounds, or that revellers would be thrown into the cells for singing "Happy Birthday" in a restaurant. Those are some of the daft stories that have been going round during the passage of the Bill.
	I want to take the opportunity to clear up a fundamental misunderstanding about the Bill. Indeed, far from spelling the end of live entertainment, as many have claimed during its passage, it will make it cheaper and easier to get a licence when one is needed, so it should be a great support for live music.
	The Bill will reduce six licensing regimes to one, to achieve four objectives—the prevention of crime and disorder; public safety; the prevention of public nuisance; and, most importantly, the protection of children from harm. I believe that it is a sound piece of legislation, which all parts of the House have been praying for, not just because it modernises licensing but because it removes a considerable amount of red tape. The days of small venues being charged thousands of pounds in some areas for a licence to stage a performance by three Somerset folk singers will soon be over. I hope therefore that 8 July 2003 will be remembered as the day on which live music was given the shot in the arm that it badly needs.
	Turning to the amendments, we are introducing a further package of measures in addition to the concession we made in the Chamber on 24 June to lighten the load on venue operators and organisers and to provide the opportunity to open up the market to a wide range of performance. That package consists of four elements. First, some amendments provide a significant concession on unamplified music, which I will explain in more detail later. Secondly, the Government have given a firm undertaking to review the existing descriptions of entertainment in the Bill six to 12 months after the end of the transition period. If it proves that the Bill has had an unintended, disproportionate and negative effect on the provision of live music, we will use the powers already in the Bill to modify the position through secondary legislation. Thirdly, we have provided an exemption for morris dancing and dancing of a similar nature from the Bill's requirements on the provision of regulated entertainment.

Malcolm Moss: Unfortunately, the Minister did not represent the Government in Committee, as he has come lately to the brief. Why, after 60 or 70 hours of debate in Committee and on Report, when we went on and on about morris dancers and the need to remove them from licensing provisions, have the Government at the eleventh hour accepted the wisdom of what we are saying?

Andrew Bennett: The hon. Gentleman should be pleased.

Malcolm Moss: It is not a question of being pleased. I prefaced my remarks by asking why could the Government not see the logic of the argument on day one instead of at the eleventh hour.

Richard Caborn: That is the last time that I shall give way because, as I develop my argument, I will answer that question, and thus avoid wasting the time of the House.
	As I said, we have provided an exemption for morris dancing and dancing of a similar nature from the Bill's provisions on regulated entertainment. Furthermore, although the review that I have just mentioned will cover all types of regulated entertainment, it will place particular emphasis on other forms of traditional entertainment. If there is a case for further liberalisation, we will respond to it.
	Finally, the Department for Culture, Media and Sport will convene a forum, comprising representatives of performers, venue operators, local authorities and others, who will have the task of maximising the take-up of reforms in the Bill. Before I go any further, let me mention the exemption for morris dancing and dancing of a similar nature. The Government would have preferred not to introduce such an amendment, but it was clear—[Interruption.] I am just giving the explanation that the hon. Member for North-East Cambridgeshire (Mr. Moss) wanted, so I urge him to listen before intervening again.
	We believe that there would have been few circumstances in which traditional morris dancing would have been licensable under the Bill. However, traditional dancers were frightened by people who ought to know better into believing that their hobby was in jeopardy, and that fear was voiced another place. The amendment does no significant damage to the structure and scheme of the Bill, and if it offers reassurance, there is nothing wrong in that. However, we believe that there were very few occasions on which morris dancing would have required a licence.
	To return to the main legislative element of the package, there have been calls in both Houses and elsewhere for the Government to introduce a de minimis measure to protect unamplified music in small pubs. When the Bill was last before the Commons, our position was that it already provided such protection. Spontaneous performances would not be licensable and, of course, in response to calls in the House, we have exempted incidental live music.
	Nevertheless, today's amendments go one step further. Their effect will be to suspend conditions attached to a licence that have been imposed by a licensing authority in respect of unamplified live music in any premises with a capacity of no more than 200 where it is performed between the hours of 8 am and midnight. To protect local residents and control those few inevitably unscrupulous or irresponsible operators, the licence will remain reviewable.
	I believe that that removes all concerns that have been raised about low-level unamplified music—such as folk guitarists, for example—in small premises. This amendment is not confined to public houses and it will benefit small folk clubs and village and community halls alike.

Kelvin Hopkins: I am interested in these welcome amendments. Will the exemption cover a traditional jazz band that is not amplified, or even an unamplified jazz big band? Will a limit be imposed?

Richard Caborn: If the instruments that are being played are not amplified, the answer is yes. However, if amplified music is being played on a bass guitar, for example, the answer is no: such an event would have to be licensed.
	I know that some people have raised the issue of instruments that require amplification in order to be heard—an electric bass guitar, for example, or an electric piano—and so cannot benefit from the concession. The answer that I have given my hon. Friend the Member for Luton, North (Mr. Hopkins) is relevant to that matter.
	A number of important points need to be made. First, the Bill's baseline is that it makes it easier and cheaper to put on any kind of regulated entertainment. We have exempted incidental live music, whether amplified or not—a very powerful concession indeed. We intend to retain the concession made here on 24 June, lightening the load on amplified music in small pubs. We will also work with our partners to maximise the take-up of the reforms on offer.
	All being well, this Bill will be passed this evening. It is now down to all concerned—performers, venue operators, publicans, licensing authorities, the police, and a whole host of others, not least the Government—to go out and make it work. We are totally determined to get the most out of these fundamental liberalisations, and I commend the amendment to the House.

Malcolm Moss: In the past few minutes, we have had the revelation of all revelations, in the sense that the Minister has admitted that the Government have finally accepted that, in the context of morris dancing—which offends no one and which causes no problem or complaint—the existing regime is not broke and there is no need to fix it.
	The same applies to the two-in-a-bar rule, however. To our knowledge, no one has ever complained to the police or local authorities that that rule was causing any difficulty. By the same logic, why are the Government bringing in regulations and legislation to ban two people playing in a bar? Why do they want to replace the present regime with one that allows no one to play in a bar, unless a licence is obtained from the local authority?
	The Government have been dragged kicking and screaming throughout the passage of this Bill. It is a bit rich for the Minister to say, at the eleventh hour, that the Government want everyone to work together to make the legislation work. There is good will on this side of the House, but it extends only to working with proposals that are sensible and pragmatic. Why should the Opposition put our shoulders to a plough which it is obvious, from day one, will not work? The Bill is firmly opposed by thousands of people at all levels of the entertainment business.
	The question that must be asked, again and again, is: why?
	Why are we doing this? Why are the Government doing this? Why did they not listen 60 or 70 hours ago to the representations that were being made to them? [Interruption.] It is no good hon. Members saying that we got there in the end. We could have saved ourselves an awful lot of work and trouble in Committee and saved ourselves an incredible number of hours of debate on the issue, yet the Government have come, at this late hour, to tell us that because the situation is causing no difficulties, they will give the concession. We knew that the situation was causing no difficulties, as did the people involved. We are perplexed in the extreme as to why the Government could not see that earlier.
	As I said, the Minister has come late to this concession. We cannot blame him for not sorting things out at an earlier stage. Indeed, perhaps we should thank him for seeing the light clearly over the past few weeks and at least doing something. We did not divide on the amendment in the other place, because we lost our own amendment. However, when one talks to people in the music and entertainment business or to people—the local authorities—who will experience the difficulty of implementing the new legislation, one finds that no one understands what is being proposed in the amendment; nor did the Minister go to great lengths to explain it this evening. To use the words of the Foreign Secretary, the amendment is complete Horlicks. It can mean whatever one cares to interpret it to mean, so when it gets to the courts it will provide the lawyers with a large amount of money and kudos. It is badly written and makes no sense to the people who will have to interpret it. It takes us no further forward, as I shall explain later.
	Throughout the passage of the Bill, the Opposition, along with musicians of all kinds, have campaigned for one thing only: fair regulation according to risk. No one disputes that live performance needs regulation. The Opposition and those involved accepted that from the start. Rightly however, they and tens of thousands of musicians and music lovers are asking why, if the Bill allows bars, or any place, to provide big-screen sport and powerful sound systems automatically at any time—

Andrew Bennett: Not again.

Malcolm Moss: We have been over the matter for 70 hours-plus and the logic of the argument is on our side. We shall continue to argue the case because we know that we are right, the Minister knows that we are right and every sane person in the country knows that we are right.
	I repeat: if the Bill allows bars, or any place, automatically to provide big-screen sport and powerful sound systems at any time, why must providing even the mildest of live music be a criminal offence unless licensed? Even now, with the Bill about to become law, the Government have yet to provide a credible explanation, as I said a moment ago.
	In the last few days, the Government seem to have shifted the goal posts yet again, to justify the unjustifiable. They are making out that live music carries such a risk of crime and disorder that licensing is the only means of dealing with it. It is worth repeating that the police recommended that the Bill should cover televised sporting events shown in bars. They said that such events are
	"quite frequently a source of disorder",
	but the Government chose not to implement that recommendation.
	The Minister recently circulated a letter in response to a question posed last week by a Liberal Member. The same question had been put by me and others in Committee and on Report and related to the fact that the Minister had twice said that the police, in the form of the Association of Chief Police Officers, had not made representations to the Government on televised sport.

Richard Caborn: I wish to quote, for the record, what the president of ACPO said in a letter to my right hon. Friend the Secretary of State, because it is very important:
	"We understand the legitimate interests and concerns of the other stakeholders. However, we believe that the amendment that restricts the conditions that can be imposed on live music in premises with a capacity limit of less than 200 to 'public safety and disorder' meets the policing requirements. It would still allow us to respond to problems of crime and disorder in a community yet still allow small events and live music to prosper. Furthermore, provision of unamplified music rarely gives rise to policing concerns. To further the interests of genuinely low level activity—for example, traditional folk music—the Association could lend its support to amendments that suspend all licensing conditions on unamplified music in small pubs. This support is conditional on there being effective review procedures in place, so that the police could take action against a small proportion of venue operators who might exploit such liberalisation.
	Many other events are used to attract customers to licensed premises be they widescreen televisions, pool competitions, quiz nights or themed food evenings. Often there are various venues with similar events, thus diluting their impact, whereas live amplified music can generate a leisure magnet, even in smaller venues . . . Chris Fox, President".

Malcolm Moss: I suppose that the House ought to be grateful to the Minister for reading out that letter, but I was dealing with wide-screen sporting events. He went further than that and read a letter that obviously embraced other issues as well.
	In the letter to the Liberal Member that was also circulated to me, the Government are disingenuous in the sense that they admit that they made mistake in not saying that ACPO had made representations about television broadcasts. Of course the letter goes on to say—this is where the disingenuity comes in—that the police have not asked that television broadcasts per se should be licensed, for example, in premises where alcohol is not consumed. How many of those big-screen sporting events take place outside pubs? Most of them take place on premises that are licensed for alcohol sales, and the police still maintain to us—no doubt, they did so to the Government some six months ago—that they feel that a problem is associated with such situations.
	On Thursday 13 June last year, the Morning Advertiser—a licensed trade paper—reported on the World cup celebrations and said:
	"In the seaside town of Worthing, Sussex, police had to fire pepper spray into the faces of rowdy fans after violence erupted outside the Checkers pub when officers tried to arrest a man for a public order offence."
	Where is the evidence of such disorder arising from the two-in-a-bar rule, or at private performances where people seek to raise funds for good causes, or at private folk and jazz clubs, all of which are exempt under the current rules? The police have not provided any such evidence, nor have the Government, yet the fine mesh of the new law will ensnare them.
	Musicians are surely justified in believing that the Government are making them a scapegoat for problems that have nothing to do with live music. They are also justified in wondering how the Government believe that introducing entertainment licensing controls on live performances where none previously applied, or have not applied for a very long time, will benefit live music at the grass roots.
	Last week, in another place, Ministers quoted the same letter from Chris Fox, president of the ACPO, as the Minister has quoted from tonight. Again, the emphasis is that
	"Live music always acts as a magnet in whatever community it is being played."
	The Opposition dispute that—some live music, yes, but not all live music. Surely it is up to the Government and the police to target those situations where the problem arises, rather than introducing a catch-all, blanket law that applies to all scenarios.

Andrew Bennett: Will the hon. Gentleman explain whether he welcomes, or opposes, the concessions that the Government have made?

Malcolm Moss: The hon. Gentleman will have to wait until about 11.15 pm to find that out. I hope that he enjoys the debate in the meantime.
	Of course, the morris dancing exemption is to be welcomed. It means that an event in which an unamplified pianist accompanies morris or similar dancing would be exempt. A solo performance by the same pianist without the dancers, however, would be illegal in any place if not licensed, unless it was a public place, a place of religious worship or at a garden fête, not for private gain.
	In lieu of the small events exemption, the Government have made further concessions for unamplified live music, which is the substance of the amendment that we are considering this evening. Perhaps we should be grateful for these crumbs from the Government's table. It is crucial to recognise, however, that this is not an exemption from licensing. The provision of both unamplified and amplified live music in venues with a permitted capacity of 200 or fewer remains illegal unless licensed. It is the potential for licence conditions that is restricted, subject to review if there are problems or complaints sufficient to trigger a review of the premises licence.
	The Government's revised amendment is, as I have said previously, rather difficult to interpret. Whichever way one looks at it, it appears both bizarre and contradictory. First, it means that performances of unamplified or amplified live music in places primarily used for the consumption of alcohol qualify for a round-the-clock exemption from noise conditions. Secondly, venues not used primarily for the sale of alcohol are subject to all conditions, including noise, between midnight and 8 am. Jukebox music is exempt due to the incidental exemption. Drinking establishments, particularly city centre bars and pubs, are the very premises already known to cause residents the most problems if they open late, which is due largely to noisy people outside the premises but also to noise breaking out from within. They, however, are to be exempt from noise conditions when live music is performed, subject to review, round the clock.
	If a small venue is not used primarily for the supply of alcohol—for example, a restaurant, a library or someone's garden—all conditions are disapplied between 8 am and midnight. That is the wording in the amendment. If it provides live unamplified or amplified music at any time after midnight up to 8 am, however, all conditions including noise would apply. That does not make any sense. Restaurants are the very places where featured live music uses low-level amplification. Such places are not associated with the antisocial behaviour that occurs in the vicinity of city-centre bars. Surely if the Government had any genuine concern for local residents' potential exposure to unwanted noise, they would impose the midnight to 8 am curfew on both amplified and unamplified live music or, better still, insist on noise conditions if either amplified or unamplified music is to be provided between midnight and 8 am.

Rudi Vis: Will the hon. Gentleman give way?

Malcolm Moss: No, I must press on.
	By a strange irony, today, the Government's appeal will be heard against the European Court of Human Rights ruling that Heathrow's residents are entitled to noise protection by restriction of night flights. In this case, the European Court of Human Rights has previously upheld the residents' argument that they are entitled to that protection under article 8 of the European convention on human rights—the right to private and family life. The Government argue that the economic benefits of night flights outweigh the residents' rights to a quiet night's sleep. I wonder whether that position is in any way related to the issue that we are debating today.

Rudi Vis: Will the hon. Gentleman give way?

Malcolm Moss: No, I must continue.
	On public safety, the Government have justified their position with claims about the inadequacy of public safety and fire safety legislation where entertainment is provided even on the smallest scale. Yet they have not produced any evidence from a qualified authority setting out how that legislation is so deficient that entertainment licensing is the only means to ensure public safety.
	By contrast, the Arts Council, with the Musicians Union, has provided at least two detailed reports by a lawyer with health and safety expertise, and a statement from a former Home Office entertainment safety expert, that suggest that existing legislation is indeed adequate to allow an exemption for small-scale performances.
	Senior officials at the local authority unit of the Health and Safety Executive confirmed only last week that risks such as those arising from trailing cables should be covered in work places irrespective of licensing. Officials in the Office of the Deputy Prime Minister, which is the Department responsible for the new fire safety laws that are due to come into force next year—well within the transition period of the Bill—also said that licence conditions should not be necessary under those laws.
	The broadcast entertainment exemption is, again, highly relevant. In the same issue of the Morning Advertiser that I quoted earlier, the front page carried a report stating:
	"In Bristol last Friday during the England game, customers were evacuated from a Walkabout pub when part of the ceiling collapsed. Five people were treated for injuries caused by falling plasterwork."
	The incident was also reported in the Bristol Evening Post on Saturday 8 June 2002. Presumably, the Government took all that into account when making their pronouncements on public safety.
	We come next to noise. There is no evidence that live music causes a significant noise problem, and no noise complaint data discriminate between complaints caused by amplified and unamplified music. The Noise Abatement Society says that noisy people outside cause the overwhelming majority of noise complaints associated with pubs and clubs. Additionally, strong powers are available to local authorities and the police to deal with noise emanating from within bars and pubs, although it is probably true that there are inadequate resources with which to implement those powers.
	Throughout the debate, the Government have conspicuously avoided mentioning noise data and comment provided by the Musicians Unions, the Noise Abatement Society, the United Kingdom Noise Association, residents associations in Soho and Covent Garden and the Institute of Alcohol Studies. The Department for Culture, Media and Sport has instead referred to a document by the Institute of Acoustics, although it initially did not even identify its title, to suggest that live music was top of the list of sources of complaint.

Andrew Bennett: On a point of order, Madam Deputy Speaker. When we debate Lords amendments, is there not a requirement for hon. Members to address their speeches to the amendments rather than repeating their Second Reading speeches for the fifth time, as the hon. Member for North-East Cambridgeshire (Mr. Moss) appears to be doing?

Madam Deputy Speaker: The hon. Gentleman is correct. I ask the hon. Member for North-East Cambridgeshire (Mr. Moss) to restrict his remarks to the amendments under discussion.

Malcolm Moss: I take your stricture seriously, Madam Deputy Speaker. I shall attempt to refer to amplified and unamplified music in every other sentence of my concluding remarks. Perhaps that will keep me well in order.

Rudi Vis: The hon. Gentleman's comments suggest that he has canvassed an audience that he thinks could go either way. Have a significant number of people come to him to oppose, or agree with, the Bill?

Malcolm Moss: It is interesting that the hon. Gentleman delayed asking that question until the final throws of the dice on the Bill. I assure him that hundreds of thousands of people, especially members of the Musicians Union and those who are associated with live music, have continuously made representations, not only to Opposition parties but to the Government, to say that the two-in-a-bar rule causes no problems. However, the Bill will remove that rule and effectively replace it with a none-in-a-bar rule. Although the amendment contains a minor concession on unamplified music, if the hon. Gentleman knew anything about music in this day and age, he would know that about 90 per cent. of it requires some form of amplification. The irony of the amendment is that it would be okay for a pub to have a huge brass band, with a row of trumpets and trombones, but one guitarist plugged into a small amplifier would need a licence. Where is the logic in that?

Richard Caborn: There would not be a brass band in a small pub because the customers would not get in.

Malcolm Moss: It might be a big pub. [Interruption.] The Minister can interject to clarify whether the analogy is correct, but it seems that he does not want to contest it because he knows that it is true.
	Promoters who want to make a business out of live music should find the new regime simpler and cheaper. We admit that. The Musicians Union also welcomes it. However, whether live music will prosper as it should in bars, pubs and restaurants remains to be seen. Pragmatically, the industry must make the best of the new law, but that does not mean that it has to accept it without criticism. It is illogical to expect the music industry to condone laws that render unlicensed solo unamplified performances illegal while bars can pack them in with big screens and powerful sound systems. It is disproportionate by any standards.
	The Government have a duty, agreed by international treaty, to ensure that everyone can participate freely in the cultural life of the community. If they want the music industry to collaborate on implementing the new laws, they should do far more than simply set up a live music forum. They must produce a set of proactive proposals of their own.

Nick Harvey: The amendments represent a small step in the right direction, and for that reason must be welcomed. The Government have made what they would like the world to view as three concessions in relation to small events exemptions. The first is that any small pub with an entertainment licence can put on music at any time permitted by that licence. Any licensing conditions that relate to noise or the protection of children will not have effect. There remain curious questions on the logic of the Government waiving two of the licensing objectives and not the other two, but at least it is progress in the right direction.
	The second concession, which is new, is that any small licensed premises, not just a pub, that puts on unamplified music will have no conditions on its licence that relate either to noise or children, or to safety or law and order, between 8 am and midnight. I do not entirely understand why the Government have chosen to distinguish for the first time between amplified and unamplified music. It is hard in principle to appreciate why unamplified music presents so much less of a problem than amplified music.
	The two conditions that are waived in one case and not in the other are safety and law and order. I do not understand why a bigger law and order issue is presented by the performance of live music depending on whether amplification is used. The only argument that I have heard on why a safety distinction can be drawn between the two is that a cable might trail from the amplification equipment. That is apparently of no concern if the performance is in a church because it is exempt, so the good Christian folk can trip on the cable and die. It is of no consequence if it is used in a school performance of something that is on the curriculum, so children can trip and die. The paramount safety issue causes a distinction to be drawn between the two conditions for performances in small premises. It is curious and illogical, but as I said at the outset, there has been a small step in the right direction, which we welcome.
	On the so-called exemption that is being offered for unamplified music, I want to probe the Minister on the relationship between the first two concessions. The small pub with a licence can put on music at any time. The unamplified music exemption for small venues operates only between 8 am and midnight. I would like the Minister to confirm that if a small pub puts on a performance of unamplified music and goes beyond midnight, although it can no longer avail itself of the second exemption, it can nevertheless avail itself of the first. I have studied the matter patiently and slowly and believe that to be the case, but I would appreciate the Minister's confirmation that that is so. The first exemption states that it applies when the second does not, so outwith the hours of 8 am and midnight, the second does not apply, and I presume, therefore, that the first can. That is important and needs nailing down.
	The only reason that I can see why there could be any difference between the two in terms of law and order or safety is that, as was said in respect of the point made by the hon. Member for North-East Cambridgeshire (Mr. Moss) about the brass band, there is essentially no such thing as unamplified music in a pub. Even under the two-in-a-bar rule, it is almost unheard of for a jazz duo not to use modest amplification. Without it, they could not make themselves heard above the general background hubbub in a pub. Even if they could be heard, it would be impossible for them to inject into their performance any sort of range. They would have to sing forte the whole time and virtually scream, getting a sore throat very quickly.

Kelvin Hopkins: Some of the points that the hon. Gentleman is making are fair and logical, but a six-piece jazz band playing unamplified in a pub, as I have done, would make a perfectly good noise and be perfectly audible, even with conversation going on at the same time. There is no problem.

Nick Harvey: I have no doubt that the noise would be good, particularly if the hon. Gentleman was performing, but the advice that I have received from acoustic experts is that to make themselves heard over the general hubbub in a pub, performers would have to sing forte the whole time and would make themselves hoarse pretty quickly. In practice, that occurs infrequently, which may be the reason why there is a difference in implications for law and order and for safety. The second case simply does not happen.
	I shall deal now with the small venue that is not a pub, whose primary purpose is not the sale of alcohol. Perhaps we are talking about a restaurant, an art gallery, a stately home, a country house, a library or someone's garden. Such premises can avail themselves of the exemption for unamplified music between 8 am and midnight, but if for any reason they want to go on beyond midnight with the performance, they are suddenly subject to the full weight of the licensing measures. Despite the fact that those concern licensed premises, it all comes down on their head. Right next door, a pub can have an amplified band performing and carry on into the wee small hours. I readily acknowledge that this is a small point, but there is a curious logical loophole, and I do not understand how the Government begin to justify it.
	The third exemption that has been granted relates to morris dancing. It is welcome but has come, as the hon. Member for North-East Cambridgeshire said, very late in the day. It refers not just to morris dancing, but to dancing "of a similar nature". Lawyers will have endless fun discussing what that might mean.

Adrian Sanders: rose—

Nick Harvey: I give way to my hon. Friend, as he might like to give us a foretaste of some of the cases that might arise.

Adrian Sanders: I am the first to admit to being somewhat confused about the definition. What activity is similar to morris dancing? Could it be exotic dancing? If so, does that not contradict the whole point of the Bill? Or is the distinguishing factor a requirement that dancers should have beards? In that case, most exotic dancers would not be covered by the Bill. I would like some clarification.

Nick Harvey: I am sure that exotic dancers will be fine if they have some bells on their legs. The Government may have decided deliberately to leave the provision ambiguous in the hope that it is never tested too far in court.
	The very modest concessions that have been made, such as they are, are welcome. They are riddled with logical inconsistencies that it is probably better for us simply to gloss over. Some of them might come back to haunt the Government, but they are making very modest progress in the right direction, so they should be supported.

Bob Blizzard: I spoke on Second Reading, in Committee and on Report about the matter that we are considering. I did not speak on the first occasion when Lords amendments came back to this House, as I was not in the country at the time.
	I wish to make two preliminary observations. First, I think that the Musicians Union, whose basic case I have supported, has over-egged that case and has not been particularly well advised in presenting it to the Government. Secondly, I spoke this evening with a Conservative member of a Conservative-controlled council who is alarmed about the idea of a small premises exemption being set at the limit of 200 people. That council could not support that figure, as it would let almost everything that goes on in a pub or anywhere other than a big venue in its authority area take place unlicensed, so we must be very careful about the amendment.
	I welcome the further concessions that my right hon. Friend the Minister has announced. It is important to distinguish between unamplified and amplified music, because of the basic fact that amplified music can be turned up as loud as the knob on the amplifier permits, so there could be problems for residents. I think that midnight is a reasonable limit. If we are licensing entertainment beyond midnight, it is reasonable to curtail that entertainment and the volume of the noise.
	I take issue with the hon. Member for North Devon (Nick Harvey) about jazz. I agree with my hon. Friend the Member for Luton, North (Mr. Hopkins) that a jazz band can make itself heard in most circumstances without amplification in the sort of premises that we are talking about.
	None the less, I think that it is important to return to the essential point—how we deal with events that were previously allowed under the two-in-a-bar rule. The important point was that, under that rule, there was a certain exemption. Small events could proceed without being caught in the net of local authority licensing. It is that net that the musicians and others who support them are concerned about, especially where there has been no history of complaints about such events.
	I ask my right hon. Friend the Minister, in working up in conjunction with right hon. Friend the Secretary of State the guidance that will be given to local authorities, to pay very careful attention to these issues. I fear that some local authorities, once they are given this responsibility, will react disproportionately to objections to applications, even though there may be no history of complaints. That is particularly relevant in rural areas, where there are not many centres of entertainment, and where a small number of objectors can assume great proportional significance to an elected member representing that area—a councillor, perhaps—who is energised by 30 complaints because he needs only 300,000 votes to get elected. In an urban area, 30 complaints may be viewed proportionately.
	I ask my right hon. Friend to exercise particular vigilance and care in devising the guidance that goes out to local authorities. The provisions of the Bill in its final stages are broadly right, but we need to ensure that local authorities do not act disproportionately and do not make a meal of giving a licence to an entertainment that frankly does not cause a problem. If we can do that, we will have a good licensing regime that strikes the right balance between allowing the kind of entertainment that we would wish to allow without complaint and protecting residents. I urge my right hon. Friend to take that route.

Tony Baldry: I shall be extremely brief in order to give the Minister an opportunity to respond. I have to say, however, that it is pretty limited to have only an hour to debate Lords amendments, which means in effect that only one Back Bencher from each side of the House is able to speak.
	I welcome the Minister's concession on morris dancing. We should welcome it when Ministers make concessions—otherwise, where is the incentive or encouragement for them to do so? Although late in the day, his concession is very welcome.
	Last Sunday was town mayor Sunday in Banbury, and we had a cock-horse festival with morris dancers from all over the country, including Yorkshire, Cornwall, Oxfordshire and Derbyshire. The Minister presented the Bill as a liberalisation, but he must understand that many people see it as a restriction. I am fortunate, because as a barrister I can construe its complicated provisions, but huge numbers of people—including morris dancers, people who run village halls and people who run parish councils—are worried about its impact. It is beholden on the Government to work out how they promulgate it fairly and straightforwardly so that people are not alarmed and understand how it will affect them.
	As an average Back-Bench Member of Parliament with 50 parishes, a huge number of village halls, large numbers of churches and a significant number of morris dancers in his constituency, I ask the Minister—[Interruption.] I do not know why Labour Members think that it is a matter for amusement—it may be the lateness of the hour—but their constituents will want to understand how the Bill will affect them. The Government are introducing a complicated piece of legislation: we have heard this evening about the wide variety of exemptions and qualifications. I shall be delighted if it provides lots of work for lawyers, but I do not see why it should be a cause for mirth among Labour Members. I am simply suggesting that it would be extremely helpful for all such groups—whether they be morris dancers, traditional dancers or parish councils— if the Government could think seriously about how they promulgate the legislation to ensure that people can easily understand it.

Richard Caborn: Let me begin by answering the case of the hon. Member for Banbury (Tony Baldry). As he knows, I did not take the Bill through Committee, thank goodness! Nevertheless, some of the outlandish claims, such as the possible imprisonment of people who sing "Happy Birthday" in a restaurant, or the necessity of licensing a postman who whistles on his round, will cause concern. I therefore agree with the hon. Gentleman that we must be clear about the guidance that we give and translate the Bill into guidance that is not only read and understood but accepted by the British public. When the measure becomes operational, I hope that considerable liberalisation will take place.
	Let me make a serious point to Opposition Members, especially the hon. Member for North-East Cambridgeshire (Mr. Moss). In my first contribution to proceedings on the Bill, I said that we were worried about public safety and crime and disorder. That is central to the measure and we are not prepared to take chances with public safety. We have consulted the police. People may or may not agree with them, but we have taken the advice of not only the police but others in authority. We cannot underestimate public safety and crime and disorder. I know that the hon. Member for North-East Cambridgeshire disagrees with some of what the police have said, but we take the clear view that we shall legislate with their advice in mind.
	My comments also apply to the hon. Member for North Devon (Nick Harvey). We have singled out public safety and crime and disorder to ensure that accidents will not happen because the measure has been weak on those matters. I hope that there is some consensus about that.
	Let me deal with the two-in-a-bar argument from the Musicians Union. Before we published the White Paper, the union told us that it needed a level playing field for live music, with permission to hold music events that involved any number in pubs and restaurants at low cost. We have delivered what the Musicians Union requested.
	I want the hon. Member for North Devon to listen carefully because I am going to try to explain the matter in words that eminent civil servants have given me. As hon. Members will acknowledge, the concession for unamplified music is much broader than that for amplified music. The time limit is a control that is in the interests of local residents and communities. It will help minimise any public nuisance that might arise through a much broader concession. After all, if people want unamplified music to go on later, it can do so if the relevant premises licence authorises that.
	Conditions that relate to public nuisance will be in place from midnight onwards. Hon. Members should bear it in mind that unamplified concessions apply to any premises that are licensed for music. That means any place, including an open space. A time limit is simply sensible. The amplification concession relates essentially to pubs and the nuisance implications are reduced. However, there is potential for closure by the police and the possibility of a review.Unamplified music does not pose the same threat of nuisance to the surrounding area as amplified music. We believe that we have accepted a sensible amendment.
	The comments of the hon. Member for North Devon about the possibility of unamplified brass band music epitomises to some extent the stupidity that has been deployed in arguments on the Bill. Anybody who sat in a small pub with a large brass band playing would probably have a case for claiming for industrial deafness.
	I take on board the points that my hon. Friend the Member for Waveney (Mr. Blizzard) made. We want to ensure that the measure is proportionate. Our advice to local authorities and other licensing authorities is to act proportionately. I hope that I can thus allay any fears about a local authority acting in a disproportionate manner.
	I believe that we have brought some sense to the words "dancing of a similar nature". It was the colleagues of the hon. Member for North Devon in another place who asked us to word the amendment in this way. I do not know whether they have belly dancers or exotic dancers in Torquay, but that is what the hon. Gentleman's colleagues in the House of Lords said. [Interruption.] We do not capitulate; we listen to people. We engaged in a sensible debate and negotiation, we reflected, and we brought back some very sensible amendments.

Andrew Bennett: The concession on morris dancing and traditional dance is very worthwhile, but may I press my right hon. Friend to consider extending the interpretation of traditional dance to cover traditional performance? Pace-eggers, soulers and similar groups go around pubs. What they do can hardly be called a dance, but it is a performance that ought to be covered by this concession.

Richard Caborn: As I said earlier, we have conceded that. We believe that many such activities do not need to be licensed in any case. That was the position that we took, but we were asked to reflect on it and we have done so. We have brought back sensible amendments: some may not be necessary, but if they reassure Members of both Houses and the general public they will have served a useful purpose.
	Lords amendment agreed to.
	Lords amendments Nos. 62D to 62J to Commons Amendment No. 62B agreed to.
	It being more than one hour after the commencement of proceedings, Madam Deputy Speaker put forthwith the Questions necessary to dispose of the business to be concluded at that hour, pursuant to Order [24 June].
	Lords amendment No. 62L in lieu of words left out of the Bill by Commons amendment No. 62 agreed to.

DELEGATED LEGISLATION

Motion made, and Question put forthwith, pursuant to Standing Order No. 118(6)(Standing Committees on Delegated Legislation),

Income Tax

That an humble Address be presented to Her Majesty, praying that the Double Taxation Relief (Taxes on Income) (Canada) Order 2003 be made in the form of the draft laid before this House on 18th June.—[Jim Fitzpatrick.]
	Question agreed to.
	Motion made, and Question put forthwith, pursuant to Standing Order No. 118(6)(Standing Committees on Delegated Legislation),
	That an humble Address be presented to Her Majesty, praying that the Double Taxation Relief (Taxes on Income) (Mauritius) Order 2003 be made in the form of the draft laid before this House on 18th June.—[Jim Fitzpatrick.]
	Question agreed to.
	Motion made, and Question put forthwith, pursuant to Standing Order No. 118(6)(Standing Committees on Delegated Legislation),

London Government

That the draft Greater London Authority Elections (Election Addresses) Order 2003, which was laid before this House on 18th June, be approved.—[Jim Fitzpatrick.]
	Question agreed to.
	Motion made, and Question put forthwith, pursuant to Standing Order No. 118(6)(Standing Committees on Delegated Legislation),

Northern Ireland

That the draft Budget (No. 2) (Northern Ireland) Order 2003, which was laid before this House on 17th June, be approved.—[Jim Fitzpatrick.]
	Question agreed to.

Animals

Ordered,
	That the Animal By-Products Regulations 2003 (S.I., 2003, No. 1482), be referred to a Standing Committee on Delegated Legislation.—[Jim Fitzpatrick.]

SITTINGS OF THE HOUSE

Motion made,
	That—
	(1) at the sittings on Monday 14th, Tuesday 15th, Wednesday 16th and Thursday 17th July, the Speaker shall not adjourn the House until any Message from the Lords has been received and any Committee to draw up Reasons which has been appointed at that sitting has reported; and
	(2) at the sitting on Thursday 17th July, the Speaker shall not adjourn the House until he has reported the Royal Assent to any Act agreed upon by both Houses.—[Jim Fitzpatrick.]

Hon. Members: Object.

BUSINESS OF THE HOUSE

Motion made,
	That at the sitting on Thursday 17th July, the Motion for the Adjournment of the House in the name of the Prime Minister relating to matters to be considered before the forthcoming adjournment may be proceeded with, though opposed, for three hours, and shall then lapse if not previously disposed of.—[Jim Fitzpatrick.]

Hon. Members: Object.

PETITION
	 — 
	Social Care Funding

Evan Harris: I want to present a petition calling for an end to cuts in social services provision that have been forced on Oxfordshire county council by the underfunding of successive Governments. It is from Mr. Kevin Preen, a man with learning disabilities, and his organisation My Life, My Choice, a local self-advocacy organisation run by and for people with learning disabilities in Oxfordshire; from Mrs. Wendy Preece, the parent of a child with complex disabilities; and from members of the organisation Force, a group of local parents, carers and supporters who have been campaigning actively to preserve and develop services for disabled children and their families in Oxfordshire, along with other campaigners in Oxfordshire.
	Those service users, carers and campaigners have collected over 20,000 names. This is one of the largest ever petitions from a single county.
	The petition states:
	Wherefore your Petitioners pray that the Honourable House of Commons will ask Her Gracious Majesty's Government to respond to our grave concerns by setting up a review of social care funding to make social care a higher priority; to ensure that adequate respite care is available by right for those who need it; and to guarantee a minimum level of provision so as to promote more widely and inclusively the health and well-being of service users and carers within their local communities.
	And your Petitioners, as in duty bound, will ever pray, etc.
	To lie upon the Table.

MOTABILITY

Motion made, and Question proposed, That this House do now adjourn.—[Jim Fitzpatrick.]

Ian Stewart: I shall begin by declaring a deep and personal interest in the subject that I intend to raise this evening—a point to which I shall return if time permits.
	I am pleased to have secured this debate, in this the European year of disabled people, to commemorate the 25th anniversary of the introduction of the Motability scheme in 1978. It allows me to pay tribute to the work of one of my illustrious predecessors as MP for Eccles, Lewis Carter-Jones, who championed disability issues and helped to craft legislation that would provide a wide range of services for disabled people. The Minister will be relieved to learn that I am not raising a complex constituency case. I can honestly say that, in my six years in Parliament, I have had only a couple of complaints about the Motability scheme, and those have been resolved.
	No doubt there are measures that could be undertaken to improve the Motability scheme, but tonight I want to applaud the work of those involved in its establishment. I hope that as policy makers, we will draw some general lessons from the bold steps that our predecessors took at a time when the economic climate was exceptionally tough; after all, the UK was then enduring the strictures of the International Monetary Fund's squeeze on spending. However, to set the introduction of Motability in context, we should go back to the introduction of the Chronically Sick and Disabled Persons Act 1970—a Back-Bench measure that was piloted through the House of Commons by a man who would become the world's first Minister for the disabled in 1974: Alf Morris, now Lord Morris of Manchester. I know that my hon. Friend the Member for Wythenshawe and Sale, East (Paul Goggins) joins me in paying tribute to his constituency predecessor, who is renowned nationally and internationally for the work that he has done for people with disabilities.
	Lord Morris has demonstrated total dedication and the vital skill of balancing a commitment to principle with the ability to negotiate, encouraging and cajoling in equal measure to deliver real benefits for disabled people. The 1970 Act introduced a range of measures covering identification, information, social services, housing, education, access to the built environment and parking concessions. As the Royal Association for Disability and Rehabilitation pointed out in its 25th anniversary review of the Act, it helped to create a demand for those things that the Act itself did not provide:
	"self determination, choice, full civil rights and the money to exercise those rights."
	So when Harold Wilson returned to power in 1974, he created the new post of Minister for the disabled, and between 1974 and 1979 four new benefits for the disabled were introduced, including the motability allowance, which is now part of the disability living allowance.
	Lord Morris recalled that a lady caller to Greater Manchester Radio's Alan Beswick show thanked him for giving her the "infidelity allowance". Leaving aside just how much that one may cost any Government, the lady was grateful for the additional money that any form of invalidity allowance would give her, and she also had the freedom to spend it as she chose.
	Before 1976, help with mobility was given only to people who could drive, so if someone was too disabled or too young to drive, no special assistance was provided. Social inclusion was a distant dream then. The motability allowance was introduced in 1976 and its value was doubled within a year. People in receipt of motability allowance were also exempt from vehicle excise duty. Those combined measures offered disabled people a real choice about how to meet their mobility needs, but it soon became clear that disabled people without other resources would not be able to purchase a car.
	The search was on for a new way to help disabled people get on the road. I stress that Motability would not have got off the ground without the finance provided by the motability allowance. That was the powerhouse for the new scheme. We then saw the development of a genuine "social partnership"—with the Government, the voluntary sector, banks and businesses coming together to establish Motability and its finance arm, Motability Finance Ltd. The whole House, including the then shadow Secretary of State, Patrick Jenkin, welcomed the initiative in a truly non-partisan way.
	I should like to pay tribute to the political input of Labour Ministers of the time: Jim Callaghan, the Prime Minister; David Ennals; Alf Morris; and, of course, Denis Healey. With other Ministers—a Cabinet Committee for the disabled was established—they set the conditions for the birth of this important service. Sir Peter Large made an important contribution from the voluntary sector. Civil servants and others were seconded to establish the service, and the Chancellor Denis Healey bravely relaxed the corset on the banks' permitted credit limit by £100 million. That was crucial to providing the necessary finance. I also want to pay tribute to the late Lord Goodman, Lord Sterling, the current Motability chair, and Sir John Quinton for their role in getting the money delivered.
	Evidence of the success of the scheme is highlighted by the following statistics. In 1976–77, help under the private car allowance cost about £2 million, or £25 million at today's prices. Our Labour Government now spend £3.9 billion on motability allowance alone with, I believe, about 2 million recipients. More than 1.5 million cars were provided in Motability's first 25 years. Disabled people can now, like the rest of us, use their cars to shop, visit family and friends and go to work—the ordinary things in life.
	Since 1997, the Government have introduced a number of measures, about which the Minister may say more, to help disabled people. Labour has established the Disability Rights Commission, extended coverage of the Disability Discrimination Act 1995, and introduced the Special Educational Needs and Disability Act 2001. Again in passing, I would like to commend the work of Springwood, a very special school in my constituency, whose official opening I was pleased to attend last month. The Government have also improved benefit provision for the disabled, including an extension of motability payments to children aged three and four.
	Against that background, I was astonished to learn that no other country in the world has followed our lead on motability allowance and Motability. I believe there are 37 million disabled people in the EU and 600 million worldwide. Surely there must be greater scope for us to promote our success abroad and offer our expertise to other countries. Motability makes the best use of money available because it is a bulk purchaser, and Motability cars form the biggest second-hand market in the UK. I know that the economic circumstances in Europe and elsewhere may not appear to be at their most favourable but, as I pointed out earlier, motability allowance and Motability were introduced in the UK at a time of severe economic stringency. However, the political will existed to tackle intractable problems and change social priorities. Political will is, as ever, the key to achievement.
	I wish Motability continued success in meeting the motoring needs of disabled people. I have already paid tribute to its chair of governors, Lord Sterling, and wish also to commend its director, Noel Muddiman, and its entire staff. I hope that in the next 25 years we will see the rolling out of finance for Motability and similar organisations set up in many other countries.
	My hon. Friend the Member for Aberdeen, South (Miss Begg) wishes to make a contribution based on her personal experience, but disability does not affect only disabled people. It touches almost every person in the country, because we all have friends and family who have disabilities. I wish to mention two important women in my life in that regard. One was my mother, Helen Stewart, who having had five heart attacks over 30 or so years, started to show signs of the onset of Alzheimer's. The pressure of caring for my mother fell on my younger sister, Margaret, and it was a great relief when, with the help of Motability, a car was bought that allowed my mother some quality of life in her remaining years. For that, I am grateful to Motability.
	The second important woman is my mother-in-law, Joyce Holding, who is seriously ill, but who is challenging the world and living life to the full as best she can. Joyce Holding is proud of this Government and the local social services in Salford, our city, because in her time of need, they have delivered the services that she desperately needs and that, to be frank, we as a family need on her behalf. Within a matter of days, Joyce received the appropriate benefits to which she is entitled, and she received her blue badge, which allows the family to take her wherever she wishes to go, when she feels able. Without being over-emotional, I repeat that disability is an issue that affects our whole society—each and every one of us.
	I wish Motability a happy 25th birthday and I hope that it goes from strength to strength.

Anne Begg: I thank my hon. Friend the Member for Eccles (Ian Stewart) for allowing me to contribute to his Adjournment debate. I applied for a similar Adjournment debate, but he got in first and was lucky enough to secure this debate tonight. I also wish to thank Mr. Speaker, who kindly hosted a reception to celebrate the 25 years of Motability in his chambers two weeks ago. It was a nice gesture that was much appreciated by the people involved.
	As my hon. Friend the Member for Eccles has said, I have to declare an interest. It does not appear in the Register of Members' Interests; it is a very personal one. I got my first Motability car in 1978 or 1979. It does not take a great arithmetical genius to realise that I must have had one of the first such cars. It was a 950 cc Ford Fiesta, which in those days people could get for nothing on a three-year leaseback. If they wanted something slightly more souped-up, they had to pay a small deposit.
	I think that there were only three manufacturers involved in Motability in the early days. Ford was certainly one, and I think that Rover was another. I cannot remember the third. Choice was very limited, but the important thing was that these were real cars. For a disabled person to have access to a real car was quite revolutionary. Before that, the only vehicles that disabled people had access to were the infamous trikes, the light blue three-wheeled cars which were, in fact, positively dangerous. They were death traps. They chuntered along at a very low speed and were really quite embarrassing to be seen in—luckily, I did not have one. They stigmatised disabled people because they made them stand out.
	I was a young teacher when I got my first Motability car, and I was soon to live 16 miles away from my place of work. I can only imagine how difficult that would have been if I had only had access to a trike. In all, I had three cars under the Motability scheme through the leaseback system, whereby the mobility allowance was surrendered and I got the car and all its maintenance thrown in. I also had two cars under the hire purchase scheme: it was important for me to be able to keep my cars longer as I became more disabled, because I had to spend more money on adapting them more elaborately.
	The Motability scheme has evolved over the years. It is now possible to get second-hand cars and powered wheelchairs through the scheme. But the key, as my hon. Friend the Member for Eccles said, was the mobility allowance, which came in in 1976, round about the same time as I qualified for it. I was perhaps one of the babies of the mobility allowance generation. The greatest tribute that I have to pay is to the great visionary Alf Morris. It was his vision, determination and tenacity in persuading people that this was the way forward that achieved something quite revolutionary. If my hon. Friend the Minister can achieve even part of that in his time at the Department for Work and Pensions, he will have achieved a great deal. I cannot emphasise too strongly how much admiration I have for Alf Morris, and for the work that he did. He changed my life, and the lives of millions of others. We owe him a great debt, and I am delighted to have been able to repay that debt by being able to say this tonight.

Des Browne: First, I congratulate my hon. Friend the Member for Eccles (Ian Stewart) on securing this important and timely debate. He has an enviable reputation as a champion of disabled people, and it is fitting that he should have secured this opportunity for the House to mark the 25th anniversary of Motability. It is also fitting that the voice of my hon. Friend the Member for Aberdeen, South (Miss Begg) should have been heard today. If ever there was an embodiment of the celebration of capability, she is it.
	I understand that yesterday the Under-Secretary of State for Foreign and Commonwealth Affairs, my hon. Friend the Member for Sunderland, South (Mr. Mullin) apologised for the fact that he was not the Foreign Secretary. Today it is my turn; I apologise for the fact that I am not the Minister with responsibility for disabled people. That distinction belongs to the Under-Secretary of State for Work and Pensions, my hon. Friend the Member for Liverpool, Garston (Maria Eagle). She is devastated that she cannot be here this evening but, unfortunately, she is unwell. My hon. Friends will know that she battled on against the symptoms of flu all evening in the hope that she could respond to this debate, but she succumbed at about 10 pm, when wisdom overcame her ambition to be here. If my hon. Friends recognise some of her passion and knowledge in the words of my speech, they will understand why.
	As my hon. Friend the Member for Eccles has reminded the House, Motability has its origins in the radical changes in mobility provision for disabled people that took place in the 1970s. Its formation was due to the determination of the late Lord David Ennals, and of Lord Morris of Manchester, who was then Minister with responsibility for disabled people. Indeed, as we have been reminded, he was the first such Minister. The then Prime Minister and Chancellor, Lord Callaghan and Lord Healey, must also get an honourable mention—the former for his staunch political support, the latter for relaxing what was described as "the corset", which limited liquidity in the banking system for lending. With the input of many others, too numerous to mention, they showed that a determination to improve opportunities for mobility for disabled people can be translated into effective action.
	As we have been reminded, in January 1976, the Government introduced the mobility allowance that provided cash help with mobility at the rate of £4 a week for all those between five and pensionable age who had a disability severely affecting mobility, whether or not they were able to drive a car. I am sure that my hon. Friend the Member for Aberdeen, South could tell us just us how much could be done with £4 a week at that time. It was, however, clear from the outset that the mobility allowance alone would not be sufficient to enable disabled people without any other resources to obtain a car. The solution was found in the form of a leasing scheme on preferential terms that would bring the acquisition of a car within the reach of most people receiving the allowance, but would also be backed up by charitable help for those for whom the allowance and their own resources still left a suitable car out of reach.
	Given that brief, the late Lord Goodman and Mr. Jeffrey, now Lord, Sterling combined their considerable business expertise to devise the charity now known as Motability, and a leasing scheme to be operated by Motability Finance Ltd., a special company working exclusively for Motability and formed by a consortium of the major clearing banks. The formation of Motability was announced in Parliament on 6 December 1977 by the late Lord Ennals and was welcomed by Mr. Patrick, now Lord, Jenkin on behalf of the Opposition. The all-party support expressed at the outset has remained fundamental to Motability ever since.
	The late Lord Goodman, founder of Motability, described the scheme as
	"a splendid example of a mixed economy".
	It has also been said that that Motability could be considered as an early example of public-private partnership. Whatever description we choose, it is important to realise that once a need became apparent and the right people came together, there was a determination to meet that need and offer disabled people the same choice of freedom and independence in personal mobility that other people took for granted. That is to be applauded and is an example to us all of what can be achieved if there is a will.
	Motability was indeed born out of a spirit of partnership and co-operation between public, private and voluntary sectors, and it is a partnership that has survived the test of time. That was very much in evidence only two weeks ago, when parliamentarians joined patrons, governors, members of Motability and representatives of disability organisations at a reception kindly hosted by Mr. Speaker in celebration of Motability's 25th anniversary year. Together, those groups have worked tirelessly to make Motability the success it undoubtedly is. On that occasion, I recollect, Lord Morris was keen to identify those who have made Motability possible and whose commitment and enthusiasm has continued over the years. However, I cannot let this opportunity pass without expressing my deep personal gratitude and admiration for all that Lord Morris achieved. It was his initiative as Minister for disabled people that led to the creation of Motability. I know and, indeed, heard on that night, that he has remained passionate in his support for the work that Motability has undertaken ever since.
	The first Motability car was supplied in 1978—I have no idea whether it was the one driven by my hon. Friend the Member for Aberdeen, South, but she must certainly have received one of the first. Since then, the scheme has gone from strength to strength. During the past 25 years, over 1.5 million cars have been provided to disabled people and their families. Motability now has four different schemes to help disabled people obtain a car using either contract hire or hire purchase agreements. There is also a scheme for the purchase of powered wheelchairs and pavement scooters. Currently, almost 400,000 people and their families benefit from the scheme that allows them to transfer all or part of their higher rate mobility component of disability living allowance or war pensioners' mobility supplement to Motability.
	In honour of Motability's 25th anniversary, Her Majesty the Queen, as chief patron of the charity, presented the keys to six new vehicles to Motability customers at the royal mews on 25 June 2003. My hon. Friend the Under-Secretary of State for Work and Pensions was there, and she was especially impressed by a lively little girl called Gemma. My hon. Friend told all of us in the Department that she had greatly enjoyed talking to Gemma.
	I am told that the vehicles on show were also interesting. They included a highly adapted van that will allow its owner to drive directly from a wheelchair, while ensuring that he remains fully independent and able to enjoy the freedom and mobility that other young people of his age take for granted. There was also a new wheelchair-accessible vehicle that will enable Gemma to travel comfortably with her family while remaining seated in her wheelchair. Provision of both those vehicles was made possible by the Government's specialised vehicles fund, to which I will refer later.
	The keys presented on that very special day will enable families to enjoy days out together and allow individuals to access work and pursue their leisure interests. They will be used by their owners to undertake voluntary work in the community. They are keys to inclusion, and they illustrate that this scheme is making a very real difference to the lives of many disabled people and their families.
	Of course, no scheme is without its critics, and Motability has not been complacent in addressing the concerns raised by its customers. This year, there has been a major restructuring of the scheme, aimed at improving customer service and providing greater flexibility in terms of lease agreements and mileage allowances.
	Nor can Motability remain immune from the effects of market forces that operate within the business world. Over the past few years, Motability has had to face the dual challenge of the weakness of the used-car market and the uncertainties and rising prices of the insurance market. In this climate, the charity has worked hard to continue to provide a choice of vehicles for its customers, while striving to keep costs down wherever possible.
	Motability is keen to remain in the forefront of advances in technology. At Wrightington mobility centre, Motability has contributed to the design and development of a static assessment rig. The work has also been funded by the Motability tenth anniversary trust. As well as at Wrightington, these rigs have also been supplied to all the other members of the forum of mobility centres.
	The rigs use world-leading technology to allow driving assessments to be carried out. This type of assessment can help restore the confidence to drive of those faced with disability later in life as the result of illness or accident. It allows their capabilities to be established, rather than highlighting what they cannot do. It helps to identify what adaptations would help them to drive, and it can be instrumental in restoring the driving licence to those who, perhaps after a stroke, have had to relinquish it.
	This year, the Government will be contributing more than £7 million towards the specialised vehicles funds that I mentioned earlier, to assist severely disabled people who need something more than a standard production vehicle to maintain their mobility. These funds are administered by Motability on behalf of the Government, and are complementary to the Motability scheme.
	Last year, Motability was able to help more than 800 people in this way, with highly specialised adaptations. I know, from my experience of talking to those who have received grants towards adapted vehicles, how highly they value the technical expertise and professionalism shown by the staff of Motability in assessing their needs and in tailoring the vehicles to their requirements. Some of the adaptations made to allow people to drive from their wheelchairs are at the cutting edge of technology, and open up the possibility of driving to people who, in years past, could not hope to aspire to that.
	Motability prides itself on keeping up to date with the considerable technological advances in the field of motor manufacturing and it strives hard to promote the needs of disabled drivers and passengers in this forum. It works with car manufactures to make them more aware of disabled people's needs, and encourages them to reflect those needs in new designs. It has already achieved some successes in that area, and I expect that more will be done as new generations of vehicles come on stream.
	Motability is itself an independent charity and works hard to secure support and funding to help applicants who need financial support towards advance payments on vehicles, driving lessons or specialist adaptations. I know that that work is supported by motor manufacturers and many other groups, which work tirelessly to support Motability.
	In conclusion, I should like to take this opportunity to thank Lord Sterling, the chairman of Motability, and all the other governors of Motability, for all that they do. I express my gratitude to Noel Muddiman, the director of Motability, and the staff of Motability and Motability Operations without whose behind-the-scenes contributions the work of Motability could not be undertaken.
	As my hon. Friend the Member for Eccles has already told the House, there is no parallel to this unique scheme in any other country of the world—
	The motion having been made after Seven o'clock, and the debate having continued for half an hour, Madam Deputy Speaker adjourned the House without Question put, pursuant to the Standing Order.
	Adjourned at twenty minutes to Twelve o'clock.